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Improving smoking cessation in first episode psychosis: a quality improvement project by the City & Hackney Early and Quick Intervention Psychosis (EQUIP)
  1. Orestis Kanter Bax1,2,
  2. Nadim Hakim1,3,
  3. Michael Jeggo1,
  4. Declan Phelan1,
  5. Timothy Stevens4,
  6. Susham Gupta1
  1. 1City & Hackney Early and Quick Intervention Psychosis, East London NHS Foundation Trust, London, UK
  2. 2Southend Psychotherapy Service, Essex Partnership University NHS Foundation Trust, Essex, UK
  3. 3Bexley Early Intervention Psychosis, Oxleas NHS Foundation Trust, Dartford, Kent, UK
  4. 4City & Hackney Quality & Performance Team, East London NHS Foundation Trust, London, UK
  1. Correspondence to Dr Orestis Kanter Bax; orestis.kanter-bax{at}


Smoking tobacco is a major public health issue and a significant cause of increased mortality. People with a first episode of psychosis are more likely to smoke and the subgroup that goes on to have schizophrenia will have a significantly reduced life expectancy to the general population. The City & Hackney Early and Quick Intervention in Psychosis Team is a community mental health team at East London NHS Foundation Trust, providing outpatient care for adults presenting with first episode psychosis. This project aimed to increase the number of smoking cessation referrals from EQUIP to national smoking cessation services to 15% of the total team caseload over 6 months initially. A secondary measure was to complete an assessment of the smoking status for 90% of the caseload at all times. Change ideas were tested using plan-do-study-act cycles. A smoking cessation referral pathway was created and disseminated to the outpatient and inpatient services. The project was discussed at least monthly at the clinical team meeting. An education and skills building session was organised and took place at the team away day and an education drop-in session for patients was organised. The project was slow to take-off and patient participation was essential in driving progress. The aim was achieved at 23 months. A collateral benefit indicated that 25.7% of the total number of smokers had been recorded as having stopped smoking during the course of this project. This project demonstrates the effectiveness of quality improvement methodology facilitated by efficient leadership, collaborative teamwork, patient participation and persistence to address a complex problem that has significant consequences to patient health.

  • quality improvement
  • attitude of health personnel
  • community mental health services
  • coronary disease
  • health promotion

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  • Contributors SG conceived and sponsored the project. NH initially formularised and led the project with help from QI members. OKB took over as the lead and prepared the initial draft for the paper. TS coached the QI team and MJ with DP participated as members. OKB, NH, MJ, DP, TS and SG jointly reviewed the initial draft, worked on revisions and corrections and agreed the final manuscript contributing equally to this process.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement One service user was involved as a full member of the QI project team and independent expert by experience advisor. Her insights drawn from her lived experience and successful smoking cessation were essential in giving this project its final form. Her personal details have been withheld for confidentiality.

  • Patient consent for publication Not required.

  • Ethics approval This work was considered exempt from ethical approval as it was deemed an improvement study and not a study on human subjects.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement East London NHS Foundation Trust is the owner of the data relevant to this study, which are available upon reasonable request.

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