Table 4.

Positive solutions that will counteract concerns about Adoption

Area of Concern	Solution	Sample Responses
Time and Stress	No effect on time or stress level if only screening is required but counseling is done by trained personnel. RN1 or RT2 should screen, and the MD3 should solely reinforce the message that quitting will help their child’s health, but a trained cessation counselor should do the assessing and assisting.	“No stress if done is a “systematic, organized studied way”
		“Make it easy and quick - Epic prompts and flags… we want EPIC autopopulation to help with the next steps based on parent answers.”
		“I think that effectiveness (of the intervention) and respect depends on the individual and their approach to it, not their title… (counseling should be done by) someone completely outside of the care team.”
		We don’t need an MD or RN to do this. The ED4 is already a place where demand outstrips capacity; the only right to healthcare we have anymore is the right to emergency/trauma care. And we can’t even do what we need to do, so why would we add extra? This should be exactly like a scribe, push the work down to someone who can do it.”
		“If I have to do it, it will negatively affect my load. I can tell you straight out-I do not want to be the one doing it.”
Patient Flow	No effect on flow if (in order of preference): Done during natural wait times Done after discharge In another room (and not the patient’s room) by a trained tobacco counselor who can tailor counseling to the parent who is interested in quitting.	“Depends on: where it’s done, how it’s done, and who does it.”
		“In a perfect world, it would be best if you hire a whole group of people who deal with this – meaning, screen with ED staff, then have other individuals trained for the other parts who can help while the patient and parents are waiting in the ED.”
		“At triage I don’t think this is an appropriate time/place to address the use of tobacco since there is no way of initiating interventions at that time. I feel like it is a question that gets asked but nothing ever gets done with the information, therefore I tend not to ask at triage.”

¹RN = Registered Nurse

²RT = Respiratory Therapist

³D = Medical Doctor

⁴ED = Emergency Department