Introduction:
Referrals from hospitals or general practitioners provide an efficient evidence-based method to connect patients to Quitlines. In a pilot project in 2019 a concept was developed to implement the "smoke-free ticket". The nationwide implementation has been supported by the Federal Center for Health Education (BZgA) since 2020. The "smoke-free ticket" bundles several advantages. For patients who smoke, telephone counseling is a free and low-threshold support service. Referring facilities support existing regulations for a smoke-free hospital environment. When intensive on-site tobacco cessation or aftercare cannot be offered Quitline services is helpful.

Material and Methods:
64 acute care hospitals, rehabilitation clinics and general practices have signed up to the project. The aim is a sustainable implementation of screening, brief intervention and referral to Quitlines. The concept includes implementation support like training of multiplicators and referral of patients interested in quitting or maintaining abstinence from tobacco.

Results:
During the first 3 years of implementation 53 sites have implemented the program and more than 5.000 patients have been referred. About 60% of the total sample were registered, reached and counseled. 30-day point prevalence abstinence rate after 3 months was 53%. This high rate is probably partly explained by the combined intervention (approach in the participating clinics plus counseling at the telephone counseling service). Another factor is the proportion of participants who were already smoke-free (36.6%). When patients were enrolled to remain smoke-free, they had very good odds of remaining smoke-free after three months (78%).

Conclusions:
The smoke-free ticket-Project was successful established, supports sustainable implementation and increases abstinence. Next steps are web-based referrals, provision of tools to improve screening and brief intervention and to include settings like dentists and occupational health.