Despite recommendations for emergency department (ED)-based preventive care, screening and caring for chronic diseases in the ED itself is challenging. The focus on acute care, high volumes, staffing shortages, budget constraints, and lack of time may be barriers for providing ED-based smoking cessation. To bridge this gap in care, observation units (OUs) can be used to facilitate preventive care practices, including smoking cessation. The OU may be a quieter, more private care setting with fewer distractions and time pressures. The OU may also have workflows more conducive to providing preventive care. Previous OU literature indicates that patients perceive admission to the OU as a “cue to action,” which could help facilitate lifestyle changes, including smoking cessation. A 2014 systematic review of 13 trials found that ED-based smoking cessation interventions were associated with higher cessation rates than the national average. The OU is a reasonable place for providers to “Ask, Advise, Refer” for smoking cessation in order to promote behavioral interventions for smoking cessation and to institute pharmacotherapy (e.g. nicotine replacement therapy) for smoking cessation.