Resident Physician Stony Brook Children's Hospital Melville, New York, United States
Background: Electronic cigarettes are the most commonly used tobacco product by adolescents. Accurate identification of adolescent e-cigarette use (vaping) on hospital admission is challenging, as vaping may not be differentiated from other tobacco product use and parents are often present for verbal screening. Objective: We aim to improve the vaping screening rate for patients aged 11-17 in the inpatient pediatric unit to 40% by December 2023, and to improve identification of vaping to match expected prevalence by June 2024. The main innovation is a paper self-screen which is collected and later transcribed into the EMR in place of verbal screening. Design/Methods: A multidisciplinary committee comprised of hospitalist physicians, a resident, nurse leaders, and a quality improvement specialist was formed. PDCA cycles included: 1. Distribution of pre-initiation survey to nursing to gauge compliance and barriers to prior verbal screening process; 2. Creation of a paper self-screen and nursing education on tool; 3. Nursing reeducation; 4. Tool redesign for improved completion; 5. Staff education on e-cigarette vs other tobacco product use.
Pre-initiation, vaping screening was completed in 21/120 (17.5%) abstracted charts. Post-initiation, from February-August, 213/507 eligible patients (42%) had a vaping screening completed. Highest monthly screening rate was 55%.
Vaping screening has improved by 24.5% on the inpatient pediatric unit. Further PDCA cycles will address partial self-screen completion, duplicate screenings, and discrepancies between the paper self-screen and the transcription into the EMR.. Balancing measures such as challenges to nursing workflow will also be addressed. Finally, additional data analysis will focus on the accuracy of vaping identification utilizing this new process. Primary outcome measures will be percent screening completion and percent positive for vaping.
