Appendix 1: Definitions

A total admitted spell refers to an overnight admission in hospital and applies to inpatients in both mental health and acute inpatient hospitals.

The 28-day outcome date is being calculated based on:

For inpatient settings: 28 days post discharge – when a patient returns to their normal environment and social cues. 

The only exception to the inpatient rule is for long stay patients. Long stay inpatients (beyond 28 days as an inpatient) should count the start of the 28-day outcome from the date the quit attempt was agreed. A length of stay cut off at 28 days has been agreed to support consistent application and reporting. As such, a discharge on day 27 would see the start of the 28-day “clock” at discharge, whereas a discharge from day 29 onwards would see the 'clock' started at the day the patient quits in hospital. It is best practice for those patients who have a 28-day outcome reported whilst an inpatient to still have an additional follow-up 28 days post discharge to check on their smoking status (this is not reported).

For maternity settings: 28 days from the point that a quit date is agreed (in most instances pregnant women are initiating their quit in the home environment).

Note: in the maternity pathway, a quit status is recorded at three points: 28 days (autonomous quit date), 36 weeks and at time of delivery.

For outpatients and community settings: the 28 days starts from the point that a patient agrees a quit date (which should be as soon as possible – ideally on the day they see the adviser).

The key outcome date is the 28-day (4-week quit). In line with local authority Stop Smoking Service definitions we have established a reporting window for collecting this date, between 25 and 42 days of the autonomous quit date. This reflects the NCSCT reporting window of -3 to +14 days. This means that the 28‑day outcome can be reported between day 25 and day 42.

If a patient has begun a quit attempt and is subsequently readmitted, then the 'clock' will continue to count, despite the forced abstinence in hospital. If the patient has lapsed or lapses whilst an inpatient and more than 14 days after beginning their attempt (in line with the Russell Standard), this should be recorded and a new attempt initiated. 

If a patient is readmitted for a long period, then the clock will still continue despite the forced abstinence (similar to the long Length of Stay principles) – this is likely to be a relatively small cohort.

Anyone who has smoked in the 14 days immediately prior to admission / booking is classed as a smoker.

This is different to many LA SSS. It should not include anyone who is currently engaged in a supported quit attempt, who has never smoked or who is classified as an ex-smoker.

Work to the NCSCT principle, a self-declaration of 'not a puff' over the duration of the quit, but specifically over the last 14 days.

When recording smoking status at the end of a supported quit, trusts should use an additional category – lost to follow-up (defined below).  This should only be used for recording of the 28-day outcome status, and for the purposes of reporting, the individual will be classed as a smoker.

Lost to follow up: Any patient where a smoking status cannot be determined at the end of the quit period (window around the 28-day quit status, for example 42 days post discharge/start of maternal quit) would be recorded as lost to follow up. As no status can be determined the default assumption should be that they have lapsed back to smoking.

The trigger point that marks the maternity record as closed. This could include a) a transfer of care to another provider, b) miscarriage, c) ectopic pregnancy, d) termination of pregnancy e) following birth (live or stillborn).

Services are considered as in-house when the bespoke offer of behavioural support and pharmacotherapy are delivered within the NHS service and are not referred out to an external third party. An in-reach service delivered by a third party could count as an in-house service as long as there is no transfer of care which stays within the NHS.

NHS specialist community mental health services commissioned by the Integrated Commissioning Board (ICB) are considered in-house, i.e. they are the beginning of the tobacco dependence programme for those service users receiving a direct referral to them.

Nicotine vaping product user. Defined as an individual who uses nicotine vaping products on a daily basis (Regular Vape User) or on a non-daily basis (Occasional Vape User). Please note that a dual smoker/vape user is classed as a smoker, as would someone who vapes who has smoked a cigarette within 14 days.

Please find more information on the ‘not a puff’ rule.

An English national standard for criteria for throughput and success rates that will enable meaningful comparisons between the services. The set of criteria and the methods used to collect the data are referred to as the ‘Russell Standard (Clinical)’ because they represent a clinical version of the Russell Standard for outcome assessment in clinical trials of smoking cessation treatments.

A smoker is counted as a 'self-reported 4-week quitter' (SR4WQ) if s/he is a 'treated smoker', is assessed (face to face, by postal questionnaire, self-reported via a digital tobacco dependency support app or online/web platform or by telephone) 4 weeks after the designated quit date (minus 3 days or plus 14 days) and declares that s/he has not smoked even a single puff on a cigarette in the past 2 weeks.

Defined as “Discussion between the patient and the Tobacco Dependence Adviser* to give advice and be able to commence a supported quit attempt, including tobacco dependence advisor support. This can be undertaken face to face (ideally) or remotely”.

* The default is for the Tobacco Dependence Adviser to deliver these services, unless exceptional circumstances are in place, such as during the COVID-19 crisis, where the use of hot/cold wards may preclude this. In such circumstances, it is acceptable (as a temporary arrangement) that other staff can provide adequate advice and support patients to start a quit attempt, with support from a Tobacco Dependence Adviser

At present, the data collection is only focused on smoking and tobacco. It is recognised that shisha use is higher in certain geographies, and local systems may choose to tailor local data collection to local needs, for example collect data on shisha usage.

In order not to double count the patients on their readmission, an additional data field “SMOKER UNDERTAKING A CURRENT SUPPORTED QUIT ATTEMPT” has been added to the specification. This should be answered “Yes” when ascertaining smoking status and only where someone is actively being supported on a current supported quit attempt (with behavioural interventions and nicotine containing products (both licensed and unlicensed)/ Varenicline/Bupropion/Cytisine. Categorising a patient in this way acknowledges their quit and would allow them to be excluded from the count of active smokers eligible for support. This would include readmissions but potentially any other admission/maternity booking where a patient is being supported prior to contact with the NHS service.

The Russell Standard provides criteria to help services understand whether a current supported quit attempt is in progress.  This is summarised below.

Quit date: Within 13 days of admission/booking/appointment

Smoking status 

Smoked within last 13 days

On current support quit attempt?

Yes

Quit date: Between 14 and 27 days before admission/booking/appointment

Smoking status: Smoked between day 14 and day 27 of quit attempt

On current support quit attempt?  No outcome the original attempt.

Smoking status: Not smoked in last 14 days

On current support quit attempt?  Yes

Quit date: 28 or more days before admission/booking/appointment

Smoking status: Smoked any time after 14 days after beginning attempt

On current support quit attempt? No.  A new attempt could be started

Smoking status: Smoked any time after 14 days after beginning attempt

On current support quit attempt? No.  A new attempt could be started

Smoking status at booking appointment.

Current smoker status - 14 days as per the Russel Standard as a snapshot at delivery.

Status should be captured at admission (to support patients in managing withdrawal) or within a local timeframe agreed as part of the clinical pathway (within 6 or 24 hours). In some instances, this will not be possible, for example patient unconscious or mental health crisis and no next of kin/family. In these cases, the status should be ascertained as soon as possible.

This should be recorded at time of booking (or earlier if the booking is not the initial contact). If missed, this should be collected and added at a subsequent appointment.

Status should be captured at every appointment and previously recorded smoking status should not be relied upon.

Note: in the aggregate data section, for outpatient settings and community settings, only patients who are having their first attendance / contact with the services for a treatment pathway are counted.

Status should be captured at admission (to support patients in managing withdrawal) or within a local timeframe agreed as part of the clinical pathway i.e. within 6 or 24 hours. In some instances, this will not be possible for example. patient unconscious or mental health crisis and no next of kin/family. In these cases, the status should be ascertained as soon as possible.

Current smoker status at the 36 week antenatal appointment - 14 days as per the Russel Standard.

The expectation is that the 28-day outcome status will be submitted by the NHS trust/provider as part of the pathway of care. This includes where the step-down care is provided by a different provider i.e. LA SSS for inpatients. There will be variable pathways and levels of digital infrastructure/integration across England, so each trust/provider will need to sort a local solution to collecting this information.

Whilst downstream providers may collect this information – where this makes sense to the care pathway such as where a referral has been made during the first 28 days of treatment – the data should always be reported by the NHS trust/provider. Pathways to capture this data should be put into place prior to any such arrangement being made.