LAUSR

Background Recent data suggests that 27.5% of high school students reported using electronic cigarettes (e-cigarettes) in the past 30 days, a rise from 1.5% in 2011. Only 37% of adolescents recognized nicotine presence in these products. Screening, educating and providing cessation counseling for adolescents using e-cigarettes is fundamental. It has been documented that physicians infrequently screen or counsel their adolescent patients about e-cigarette use. According to a recent study, physicians using advanced electronic medical record (EMR) systems were more likely to record smoking status, and counsel patients on smoking cessation than those using less sophisticated technology, hence the idea to encourage the use of the e-cigarette/vaping screening tab in the EMR during adolescent visits. Aim Statement To improve e-cigarette/vaping use screening among adolescents attending school-based clinics to a minimum of 80% in six months by encouraging the use of a specific tab embedded in the EMR. Interventions This quality improvement project included a baseline retrospective chart review of 100 health maintenance and sports physical visits in four school-based clinics associated to a major Academic Medical Center in Miami, Florida. The first Plan-Do-Study-Act (PDSA) cycle consisted of an email sent to health care providers encouraging them to utilize the e-cigarette tab in the EMR. Measures 100 charts were reviewed one month after the intervention to assess whether e-cigarette use or vaping was assessed at health maintenance and sports physical visits in the same four school-based clinics. Results At baseline (September-October 2019) 23% of adolescent patients were screened for e-cigarette/vaping use. This varied by school location, ranging from 12-36%. In the first PDSA cycle (November-December 2019) 55% of adolescents were screened. This varied by school location, ranging from 16-88%. Conclusions and Next Steps Encouraging health care providers to use a designated e-cigarette screening tab embedded in the EMR through an email alert increased the number of patients screened during their health maintenance or sports physical visit. One of the four school-based clinics exceeded the goal of screening at least 80% of adolescents. Because locating the e-cigarette tab was identified as a barrier by some health care providers, a second intervention that included step-by-step information about where to access the tab was implemented. Results for the second PDSA cycle will be available February 2020.