Background: The needs of the developing child are urgent. Opportunities for best care lost or gained during pregnancy last a lifetime. Creating opportunities for smokefree change is of paramount importance for the pregnancy care team. In support of this, Smokechange, a smokefree pregnancy referral service, has an urgent response standard of 48 hours from referral to established contact. This is to maximize the impact of the discussion that led to the referral and to promote the importance of action.

Strategy: The 48 hour urgent response is demanding, requiring multiple attempts and methods for contacting participants who are often living transient and troubled lives. A quality initiative was carried out over 8 days during November 2006 to understand the challenges in making contact. Team members focused their efforts on meeting the standard and when unable to do so, passed referral details to a colleague who was designated to keep trying. 12% of referrals were passed, extra attempts to contact averaged 4.6/person (range 2-7), contact was made with all but one person, a first session achieved for 64% and other support option offered to 27%. More important than the improvement from the extra effort was the improvement across the whole team. First session rates increased from 67% of referrals in October to 80% in November.

Conclusion: This initiative highlights the strength of focus for improving access to smokefree support in pregnancy. An immediate response to referrals conveys to families the importance of action and the urgent need to protect the developing child.