Problem/Objective: Hospitals fear that implementing a smoke-free campus policy will increase staff shortages and decrease patient volume. When our hospital, a rural 180-bed acute care facility located in a small town, went smoke-free on July 1, 2006, we monitored these outcomes.

Methods: Inpatient volume and percentage of inpatients who currently smoke (obtained from electronic medical records), employee tobacco use rates from annual occupational health assessments and employee retention are compared pre and post-ban. During the year preceding the ban, 150 employees participated in a cessation program offered by Employee Health. Smoke free hospital signage, public notice and staff education were completed before the ban.

Results: With an average of 2,200 hospital employees, employee retention has not changed significantly pre- and post-ban. The monthly average for the percentage of inpatients who currently smoke has remained at 21.6% post-ban, following an unexpected increase in that percentage (27%) the month the ban was instituted. The pre-ban employee self reported smoking rate for the same four month period (March to June) was 14.3% in 2005 and 14.8% in 2006. Post-ban data for this same time period will be available in July 2007. The primary adverse effect of going smoke free has been a sharp increase in neighborhood complaints because the ban appeared to shift smokers (employees and patients) off hospital property onto contiguous residential properties.

Conclusions: Although concerns regarding employee retention and patient volume were unfounded, a significant unexpected adverse outcome occurred in public relations, i.e. an increase in neighborhood complaints.