P1049 - Improving Standardized Screening for E-Cigarette and Vaping Use Among Adolescents

Background: Electronic Cigarettes (e-cigarettes, EC) constitute the number one vehicle for tobacco product use by adolescents in the United States since 2014. Data from 2019 suggests that 27.5% of high school students reported using EC within the preceding 30 days, but only 37% recognized the presence of nicotine in it. Users of EC are at risk of developing E-cigarette or vaping product use-associated lung injury (EVALI) a life-threatening complication. Although the AAP recommends screening, education and cessation counseling for EC use, only 14% of physicians do it. Physicians using Electronic Health Record (EHR) systems are more likely to record smoking status, counsel patients on smoking cessation, and prescribe medications to support cessation compared to those using less sophisticated technology. Hence, the idea to encourage the use of the e-cigarette/vaping screening tab in the EHR during adolescent visits.

Objectives: We aimed to improve the percentage of adolescents screened for EC/vaping use during their health maintenance visits or sports physical visits at University-affiliated school clinics from 12% (lowest performing clinic at baseline) to at least 80% within six months.

Methods: Using the model for improvement, we performed reiterative Plan-Do-Study-Act (PDSA) cycles to test and implement several interventions: [1] a streamlined screening process and reminders sent to school clinic providers encouraging the use of the EC tab embedded in the EHR [2] buy-in from medical staff and guided instructions to providers on accessing and documenting EC screening in the EHR. A bi-monthly chart review of 25 health maintenance and sports physical visits in four school clinics, both at baseline and after each PDSA were included. Run chart was created to display data overtime.

Results: Between October 2019 and February 2020, 300 encounters corresponding to adolescent patients were reviewed for EC/vaping use at 4 school-based clinics. At baseline, an average of 23% of adolescent patients were screened for EC/vaping use and following the second PDSA cycle the mean percentage increased to 89%. One of four clinics reached the goal of screening 80% of adolescents after the first PDSA cycle, whereas three of four reached the goal after the second PDSA cycle (Figure 1). Screened patients who reported use (3%) received education and counseling.

Conclusion: Electronic cigarette screening improved in all four clinics after two PDSA cycles. A streamlined process, buy-in from providers, and reminders to use a designated tab embedded in the EHR, allowed for more than 80% of adolescents to be screened during their health maintenance or sports physical visits. Future directions include continuing intervention [2] and implementing “preoccupation for failure” strategies during our third cycle. In addition, we seek to offer education, cessation counseling, and referral to those adolescents who screen positive for EC/vaping use.