Table 5.

Factors that would enhance Implementation of the intervention steps into routine pediatric emergency department practice

Factors	Data	Sample Responses
Technical Support	Practitioners emphasized the attractiveness of: “clicks” EHR1 order sets with “drop-downs” completion “flags”	“‥One click to do the screening which is linked to the (secondhand smoke-related) chief complaint…(this click) starts the (intervention) process, then a second click sets off the counseling cascade.”
		“‥Clicks” that “auto-populate to the next steps”
		“Epic order set with drop-downs to facilitate the counseling” or an “EPIC order for a cessation counselor.”
		“‥flags that are visible to the physician that shows the identification of parental smokers and indicate that each step (e.g., advice, pamphlets, referrals) was given.”
Financial support	Necessary for: technical help cessation counseling training tobacco cessation experts cessation resources	“We need financial support for this effort because: … this ultimately relates to our mission of being leaders in providing improved outcomes to the patients we serve” …this is a major determinant in the health and recidivism of our patients and one of our clinical priorities is to improve asthma care” … I think that for certain families it (second hand smoke) probably plays a big role in how often their kids get sick and severity of illness and that counseling will prevent future illnesses.”
		“…A tobacco cessation counselor or someone whose area of expertise is smoking cessation. I think that in a primary care setting, the doctor has a lot of influence, that is assuming that the doc/patient have good rapport. In the ED2 setting, I think the clinician should be removed from these discussions, because from a patient’s perspective, it would be hard to think that it wasn’t affecting their child’s care.”

¹EHR = Electronic Health Record

²ED = Emergency department