TOPLINE 

An automated interactive voice recognition (IVR) system successfully identified and contacted adult smokers discharged from two emergency departments (EDs), and although most of them expressed interest in smoking cessation assistance, only about 1 in 5 accepted a Quitline referral.

METHODOLOGY

• Researchers conducted an implementation evaluation of an automated smoking cessation referral program using electronic health record data from two EDs at an academic medical center in the US between 2021 and 2025.
• Among adult ED patients (85,200 unique patients and 165,433 ED visits), researchers identified current smokers discharged home and assessed their eligibility for automated IVR outreach delivered 7-14 days after discharge.
• The outcomes were the prevalence of current smoking, eligibility for IVR outreach, successful telephone contact, interest in smoking cessation support, and acceptance of a referral to the South Carolina Tobacco Quitline.
• Researchers also evaluated associations between patient characteristics and implementation outcomes and conducted a follow-up survey among patients who accepted (n = 25) or declined (n = 25) a Quitline referral to assess smoking status and engagement with smoking cessation services.

TAKEAWAY

• A total of 17.6% of the ED patients were current smokers, of whom 89.0% were eligible for IVR outreach and 24.0% were reached by phone. Of those reached, 83.6% expressed interest in smoking cessation support and 21.8% accepted a Quitline referral.
• Patients with at least two ED visits had a higher prevalence of smoking than those with a single ED visit (21.2% vs 16.0%); however, they were less likely to be reached by IVR than those with a single ED visit (12.7% vs 30.2%).
• Among patients reached by phone, referral acceptance was higher in patients aged 55 years or older than in those aged 18-24 years (odds ratio [OR], 6.9; 95% CI, 4.2-11.3), in non-White patients than in White patients (OR, 1.7; 95% CI, 1.4-2.0), and in patients with at least three ED visits than in those with one ED visit (OR, 1.5; 95% CI, 1.1-2.1).
• Follow-up survey results revealed that 90% of the patients were still smoking about 4 weeks after ED discharge. Among patients who accepted a Quitline referral, 68% reported connecting with the service, and 59% received smoking cessation medication.

IN PRACTICE

"The automated tobacco screening and referral system described represents a relatively low-cost strategy for reaching current smokers upon discharge from an ED," the authors wrote.

SOURCE

The study was led by Avery Roberson, Medical University of South Carolina, Charleston, South Carolina. It was published online on June 29, 2026, in Internal and Emergency Medicine.

LIMITATIONS

The study was limited by its observational implementation design, reliance on self-reported smoking status recorded in electronic health records, low response to IVR outreach, and the small follow-up survey, as respondents may not have represented all referred patients.

DISCLOSURES

The study was funded by the Carolinas Consortium, the South Carolina state tobacco fund allocated to the MUSC Hollings Cancer Center, and the National Cancer Institute Cancer Center Support Grant. One author reported being employed by the vendor operating the Quit Plan Manager system, and two reported receiving payments as expert witnesses in litigations filed against the tobacco industry. Details are available in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.