Hospitals are key settings for the provision of smoking cessation care. Limited data are available that describe the prevalence and type of such care delivered routinely in this setting. We reviewed studies conducted in hospitals and published between 1994 and 2005 that reported levels of smoking care delivery. This review describes the proportion of patients receiving, and the proportion of health professionals providing, various smoking cessation care practices. We used both descriptive and meta-analytic methods. According to the meta-analysis, smoking status was assessed in 60% of patients, 42% were advised or counseled to quit, 14% were provided with or advised to use nicotine replacement therapy (NRT), and 12% received referrals or follow-up. Significantly fewer patients received follow-up or referrals than were assessed for smoking status or received advice or counseling to quit. Some 81% of health professionals reported they assessed smoking status, 70% advised or counseled patients to quit, 13% provided NRT or advised its use, and 39% provided referrals or follow-up. Significantly fewer health professionals advised or prescribed NRT than assessed smoking status or advised or counseled patients to quit. Statistical heterogeneity was indicated for all smoking care practices. Levels of smoking cessation care are less than optimal in hospitals, and the levels of some important care practices are particularly low. Future research should identify effective methods for increasing smoking care provision in this setting. In addition, standardized measures of smoking care should be developed. Hospital organizations should enhance and continue to monitor their delivery of smoking care.

Interventions can be effective in increasing the routine provision of hospital smoking cessation care. Future research should use more rigorous study design, examine a broader range of smoking cessation care practices, and focus on hospital-wide intervention implementation.

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BACKGROUND In recognition of the adverse consequences of tobacco use on patient health, 1 the financial burden of smoking on the health care system, 2 and the role of health services in the treatment of tobacco users (to enable their cessation of smoking), the NSW Department of Health has implemented a number of smoking cessation initiatives in recent years. Among these are the 1999 NSW Smokefree Workplace Policy, which requires all area health service facilities and campuses to become smoke-free, 3 and the development and release of the Guide for the Management of Nicotine Dependent Inpatients in 2002. 4 This article describes the implications of the NSW Smokefree Workplace Policy on hospitals and discusses the development and utility of the Guide in the context of the ongoing challenge of improving care for inpatients who are dependent on nicotine.

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