Tobacco Treatment in the Inpatient Setting: An American College of Chest Physicians Clinical Practice Guideline.

TL;DR

This ACCP clinical practice guideline synthesizes evidence for tobacco treatment in hospitalized patients, recommending an opt-out population-based approach combining counseling and pharmacotherapy. Eight recommendations address inpatient and post-discharge tobacco intervention components, though most are supported by moderate or lower certainty evidence.

Key findings

• Hospitalization represents a critical opportunity to initiate tobacco cessation treatment through an opt-out population-based approach offering counseling and pharmacotherapy to all smokers unless declined
• Only four of eight recommendations were supported by moderate-certainty evidence; no recommendations were supported by high-certainty evidence specific to inpatient settings
• Guideline addresses pharmacotherapy selection, counseling during admission, and post-discharge follow-up interventions to improve smoking-cessation outcomes and reduce readmissions
• Identified priority research gaps include optimal implementation strategies, equity considerations, and cost-effectiveness evaluation across diverse hospital populations

Why this matters at the bedside

Directly applicable to clinicians managing hospitalized smokers. Provides structured recommendations for systematic tobacco screening and treatment integration into inpatient care, with potential to reduce preventable morbidity and hospital costs. Limited by modest evidence certainty for most recommendations.