Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban.
Renata Marques de Oliveira, Jair Lício Ferreira Santos, Antônia Regina Ferreira Furegato
PMID 35920539WHAT IT FOUND
In a psychiatric hospital, the smoking ban was followed by fewer verbal and physical aggressions and lower costs for psychotropic drugs and expectorants.
Hospital admissions and stays also dropped, mainly in public male units, contradicting fears that bans increase aggression.
Key findings
01Verbal aggression, physical aggression, referrals to special care, anticipation of psychotropic drugs, and chemical restraints all showed statistical evidence of decreasing after the smoking ban.
02Overall hospital indicators (admissions, patient-days, occupancy, length of stay) decreased significantly after the ban, but this reduction was concentrated in public units, particularly male wards, rather than the private unit.
03Costs for psychotropic drugs and expectorants decreased after the ban, with statistical significance found only for oral promethazine and oral clonazepam.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study analyzed only six months of data before and after the ban, which may be too short to capture long-term trends or all differences. Data relied on medical records, so behaviors like aggression or escape attempts may have been under-recorded or inconsistently documented (information bias). As an ecological study using aggregated data, it cannot determine if the changes occurred in the same individuals or if smoking status was accurately recorded for every patient (risk of ecological fallacy). The study was conducted in a single philanthropic hospital in Brazil, so results may not generalize to other healthcare systems or cultural contexts.
The easy way to misread this
Do not assume that the smoking ban directly caused the reduction in aggression or costs for every individual patient. The study uses aggregated hospital data, so it cannot link specific patients' smoking cessation to their individual outcomes. Additionally, the reduction in admissions and stays was not uniform across all units, suggesting other factors may have influenced the hospital's operations during this period.