SMOKING STATUS AS THE NEW VITAL SIGN - EFFECT ON ASSESSMENT AND INTERVENTION IN PATIENTS WHO SMOKE

Objective: To assess the effect of expanding the vital signs to includ e smoking status. Design: We prospectively conducted exit interviews w ith patients at a general internal medicine clinic in Madison, Wiscons in, during a 16-month period from 1991 to 1993. Methods: Patients were surveyed briefly before (N = 870) and after (N = 994) the implementat ion of a simple institutional change in clinical practice. This change involved training the staff in how to use progress notepaper with a v ital sign stamp that included smoking status (current, former, or neve r) along with the traditional vital signs. Included in the survey were questions about whether the patient smoked, whether the patient mas a sked that day about smoking status (by a clinician or other staff), an d, for smokers, whether they mere urged to quit smoking and given spec ific advice on how to do so. Results: After expansion of the vital sig ns, patients mere much more likely to report inquiries about their smo king status on the day of a clinic visit (an increase from approximate ly 58% at baseline to 81% at intervention; P<0.0001). The vital sign i ntervention was associated with significant increases in the percentag e of smokers who reported that their clinician advised them that day t o quit smoking (from approximately 49% at baseline to 70% during the i ntervention; P<0.01) and in the percentage who reported that their cli nician gave them specific advice that day on how to stop smoking (from approximately 24% at baseline to 43% during the intervention; P<0.01) . Conclusion: Expanding the vital signs to include smoking status was associated with a dramatic increase in the rate of identifying patient s mho smoke and of intervening to encourage and assist with smoking ce ssation. This simple, low-cost intervention may effectively prompt cli nicians to inquire about use of tobacco and offer recommendations to s mokers.