Using Shared Decision Making and Telemedicine to Increase Tobacco Treatment and Reduce Complication for Orthopaedic Patients

Grant Application

Esa M. Davis, MD, MPH, UPMC Presbyterian

 

Proposed Innovation

Smoking contributes to a host of poor outcomes after surgery — from increased hospital readmissions and wound infections to graft rejection and delayed bone healing. Programs to stop smoking can reduce these complications, but they are underused by both patients and their doctors.

This Beckwith Institute-funded program will pilot the novel use of telemedicine as part of a presurgical tobacco treatment program among patients undergoing total knee or hip joint replacement at the UPMC Shadyside Orthopaedic Clinic. Through this collaborative project with UPMC Tobacco Treatment Services, UMPC Telemedicine Services, and orthopaedic surgical team, patients will engage with tobacco treatment counselors in shared decision making (SDM) regarding their tobacco use and treatment prior to surgery.

 

Improvements in Action

Orthopaedic surgeons, clinical staff, patients, families, and tobacco specialists will work together to develop a tobacco cessation plan. Using the convenience and accessibility of UPMC telemedicine technology, participants will learn:

  • How smoking can adversely affect surgical outcomes
  • Current information about treatment available, including medications
  • How to implement a successful quit plan

In testing the SDM method as an important tool in the tobacco cessation process, the program hopes to:

  • See an increase in patients engaged in shared decision making regarding tobacco use prior to surgery
  • Achieve a reduction in wound complications following surgery
  • Provide ongoing support for patients and family members so they can remain tobacco free throughout the perioperative period

 

Results – In Progress

Research on the use of tobacco treatment in orthopaedic settings is limited. This project will provide valuable data and insight on the optimal start time and length of tobacco cessation treatment for these patients. The successful implementation of this program within the UPMC Shadyside Orthopaedic Clinic could provide a model for delivering tobacco cessation support to other UPMC patients scheduled for elective surgery.