Utilization of acupuncture services in the emergency department setting: a quality improvement study
Kram J (presenter), Baumgardner D, Burns J, Xiong V, Stark Casadont J, Mullen T, Conway N. Utilization of acupuncture services in the emergency department setting: a quality improvement study. Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.
Presented at North American Primary Care Research Group 46th Annual Meeting; November 9-13, 2018; Chicago, IL.
Context: As opioid fatalities rise, alternative treatments in the emergency department (ED) are warranted for pain management. Acupuncture, a non-pharmacologic treatment involving insertion of needles into skin/tissue at specific points within the body, may decrease acute pain experienced by patients seeking ED services.
Objective: Assess utilization and impact of ED acupuncture for pain management. Study Design: Prospective enrollment, retrospective review, quality improvement study; descriptive statistics, paired t-tests used to determine differences in pre/post-acupuncture pain, stress, anxiety, and nausea scores (e.g., no pain  - worst pain ); regression models.
Setting: Milwaukee County, WI, USA. Patients: Adult ED patients during 2017 were offered acupuncture services based on emergency severity index (ESI; highest severity  - lowest severity ), reason for visit, and physician approval.
Results: 379 patients received acupuncture services (mean age 47.5 years and BMI 30.8 kg/m2). Patients were predominately female (68.1%) and White non-Hispanic (77.0%), with ESI score of 3 (68.9%) or 4 (24.8%); 46.4% received opioids in ED. Following enrollment, patients had 8-15 needles placed (86.0%) and received 20 or 30 minutes of needle time (92.6%). Mean pre/post-acupuncture pain (6.5 vs. 3.4), stress (5.7vs. 1.9), anxiety (4.8 vs. 1.6), and nausea (1.6 vs. 0.6) scores were significantly different (p<0.001). Increasing patient age predicted improved pain scores; receiving pain medication in ED was not associated with improved pain scores. Female gender and pain medication administration in ED predicted improved stress scores. Overall, patients mean length of stay in the ED was 194 minutes, with 10.6% of patients admitted to the hospital. Following ED discharge, <2% received acupuncture services within 30 days.
Conclusion: Patients in ED with acute pain experienced significant decreases in pain, stress, anxiety, and nausea with acupuncture. While further study is warranted, acupuncture may be an alternative treatment to opioid use in selected patients during ED admission.