Acupuncturists Working in the Emergency Department at the Aurora Health System of Wisconsin: A Success Story
Megan Gale
key words: interview, acupuncture for acute pain, acupuncture in the emergency department (ER), examples of acupuncture and integrative health programs in modern health care systems and hospitals, research literacy
Quick Outline
Introduction
The Study
The Program
References
Introduction
Wouldn’t it be great, as a patient, to have access in your local emergency room (ER) to non-pharm therapy option for relief of your strong pain, nausea, or GI symptoms, especially if you have adverse reactions to some medications? Wouldn’t it be useful, as a provider in the Emergency Department (ED), if you had the ability to refer to a non-pharm therapy within your ED to help ease common ED presenting symptoms of pain, anxiety, stress, and nausea?
I met John Burns, DPT, MSOM, at the Academy of Integrative Health and Medicine (AIHM) conference in San Diego in September where he was presenting his ED work at Advocate Aurora Health Care of Milwaukee, Wisconsin, in a poster session. His study looked at the practicality of offering acupuncture services in the ED of a Wisconsin hospital. And, with enthusiasm, I watched him receive first place in the poster session for his team’s work!
Background
Dr. Burns has a doctorate degree in physical therapy and a master of science degree in oriental medicine from Midwest College of Oriental Medicine, Racine, Wisconsin. For the past 4 years Dr. Burns has been the manager of the acupuncture services program at Aurora Health Care, Sinai Hospital. During a lunch break at the AIHM conference, I interviewed Dr. Burns about his ED study from the poster, and about the Aurora Acupuncture program.
Dr. John Burns and poster of his ED study at the 2018 AIHM conference in San Diego, CA. photo credit Megan Gale
Part 2: The Study
More about the AIHM Research Poster Submission
Site of the study presented in the poster: Emergency Department, Aurora West Allis Medical Center, West Allis, WI.
What was Dr. Burns’ inspiration for the project?
With a smile, Dr. Burns notes it was the research study on acupuncture into the ED setting of the Allina Health system of Minnesota by Adam Reinstein and Jeff Dusek that inspired him. The Allina ED study was published in 2017 in the peer-reviewed scientific journal, Pain Medicine[1].
Poster Title
“Utilization of Acupuncture Services in the Emergency Department Setting: A Quality Improvement Study” by John Burns, DPT, MSOM, Jessica J.F. Kram, MPH, Vashir Xiong, MSOM, Jeanne Stark Casadont, MSOM, Tiffany Mullen DO, Nancy Conway, MS, Dennis Baumgardner, MD
Background and Reason for this ED Pilot
Patients often present to the emergency department (ED) for pain. Acupuncture may decrease acute pain experienced by patients seeking ED services. Acupuncture is an evidence-based, non-pharmacologic option for pain relief and pain management[2].
Goal of the Pilot
Dr. Burns notes: “the major purpose was to determine acceptability of acupuncture in the ED as either adjunctive or optional care for patients.” The study was the first to assess the impact of acupuncture in the ED for pain management in the Aurora Health system. The researchers wanted to determine acceptability of the acupuncture program by the patients and the ED staff. This was a quality improvement study.
Methods
This was a retrospective observational study of patients in the Emergency Department.
Patients admitted to the ED were offered acupuncture treatment for their acute pain condition based on their:
Emergency severity index (ESI)[3]
Reason for visit
Their physician’s approval
What Electronic Health Record (EHR) program do you use?
Aurora uses EPIC for documentation. Dr. Burns worked with IT staff to create a specific data field in the EHR to track outcomes from the acupuncturists’ progress notes.
Measurements/Metrics Used in ED study
In the ED study, they tracked patient-reported outcomes. The top 3 measures were: pain, stress, and anxiety. The symptoms were measured on the numeric rating scale (NRS), of 0-10 for each.
Striking aspects to note about the study
The demographics of the patients treated represented the demographics of the local ED.
When patients were treated by the ED acupuncturist, they received only acupuncture. For example, some patients had less than 8 needles per acupuncturist’s discretion, and some did not retain the needles past 20 minutes due to other services needed (such as x-rays).
What are important points/take-aways from this study?
Acupuncture reduced acute pain. In the study, patients who received acupuncture reported 50% pain relief (average).
Acupuncture reduced symptoms of nausea by about 60%.
Acupuncture in the ED setting is feasible .
Where is the Emergency Department (ED) research published?
Dr. Burns’ paper was published April 2019 in the Journal of Patient Centered Research and Reviews. Please see the citations at the end for more information.
Review of Clinical Program Implications for this Study
Availability of acupuncture services in the ER increases ease of access to non-pharm pain relief. And, for someone admitted to the hospital, having acupuncture as an option in the ER and the inpatient unit may decrease the complexity of their medication panel. It may reduce the medication panel complexity because it reduces the common symptoms nausea, stress, anxiety, and pain without medication (non-pharm therapy).
Considerations for future studies
Dr. Burns noted: “This [study] was only a pilot program to determine if acupuncture would be accepted by ED patients and staff. This was not a controlled study or a study that followed patients over a period to determine changes in their behavior.”
He says, “Next plan is to repeat the study with a different demographic and provide free follow-up care.”
Reproduce the ED project in Milwaukee, WI, in next year with different patient demographics
Track whether availability of acupuncture in the ED reduces opioid prescriptions
Follow up with patients who receive acupuncture in the ED at an outpatient clinic. No follow up with the patients was performed for this pilot program due to study limitations. They found that “following discharge from the ED, less than 2% received acupuncture services within 30 days.” Assumptions about why this may be: patient choice, lack of reimbursement, even though outpatient services were available at the West Allis site.
[1] Adam S. Reinstein, Lauren O. Erickson, Kristen H. Griffin, Rachael L. Rivard, Christopher E. Kapsner, Michael D. Finch, Jeffery A. Dusek; Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study, Pain Medicine, Volume 18, Issue 1, 1 January 2017, Pages 169–178, https://doi.org/10.1093/pm/pnv114
https://academic.oup.com/painmedicine/article/18/1/169/2924684
[2] The Consortium’s Pain Task Force White Paper.
Tick H, Nielsen A, Pelletier KR, et al. Evidence-Based Nonpharmacological Strategies for Comprehensive Pain Care. The Consortium Pain Task Force White Paper. 2018.
[3] Emergency Severity Index (ESI) is a triage algorithm that measures urgency of case on a scale of 1 to 5. “1” indicates the highest degree of urgency and “5” is the lowest degree, developed by Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health and Human Services (HHS). https://www.ahrq.gov/professionals/systems/hospital/esi/index.html
Dr. John Burns awarded first place of the AIHM 2018 posters. photo credit Megan Gale
Part 3: Acupuncture in the Aurora System
The acupuncture program at Advocate Aurora began in 2002 with one acupuncturist. The program now employees 11 acupuncturists, full-time and part-time, who provide care in 11 oncology clinics, 7 outpatient clinics, 2 inpatient units, and one emergency department. Acupuncturists in the program are employees of Aurora.
The acupuncture program is part of Aurora’s Department of Integrative Medicine (IM). The IM department employs practitioners who provide the following services: massage therapy, chiropractic care, acupuncture, aromatherapy, and mind-body exercise. The mind-body exercise therapy program is at Aurora’s psychiatric hospital.
Program Funding and Sustainability
The program is sustained through philanthropic funding and cash-based service.
Outpatient acupuncture services are cash-based except for the ED study program. The ED program is sponsored by Aurora at no charge to the patients. The oncology clinic acupuncture program is supported through both philanthropic funding and cash-based services.
How is program success or failure measured?
The Aurora IM programs are measured with the new model of care: value-based metrics, particularly outcome-based measures. Program success is not measured solely by RVUs or patient load.
More about what Dr. John Burns does and where he works
Dr. Burns teaches Tai Chi and Qi Gong to patients in the mental health clinic and psychiatric hospital. This clinical care has been well-received by patients and by staff who have seen patients’ positive response to it. Dr. Burns also does in-service presentations to the following provider types: acupuncturists, physical therapists, nurses, occupational therapists, and physicians.
Dr. Burns’ Vision for the Aurora Acupuncture program:
Dr. Burns believes acupuncture, as an integrative health paradigm, has a “patient empowering philosophy”. His hopes to see acupuncture available in all services lines, but especially incorporated into the following services: neurology, palliative care, and the back and spine group. He feels the integrative medicine program will benefit when acupuncture services are covered by the following insurances: Medicare, Medicaid, and the Aurora employee health benefits system. He would like to bring acupuncture into the mental health clinic as part of the substance abuse treatment program.
On being a manager of an integrative health program:
Dr. Burns has been in a management position for 4 years. He wants his LAcs maintain work-life balance. He understands that clinician resilience and program sustainability are inter-related. So, he makes this a priority in his role as program manager.
What learning opportunities are available to integrative health students and practitioners interested in hospital-based practice?
Shadowing opportunities are available in his program. The integrative health courses that teach self-care may be soon be open to the public.
References Section
Contact information for Dr. Burns and the Aurora Acupuncture Program
email: john.burns@aurora.org
program website: https://www.aurorahealthcare.org/services/integrative-medicine/acupuncture
Links to related publications on the Aurora ED Study
April 2019 updates
research work was published April 29th, 2019 in a peer-reviewed scientific journal, Journal of Patient-Centered Research and Reviews (JPCRR), “Utilization of acupuncture services in the emergency department setting: a quality improvement study”
citation is:
Burns JR, Kram JJ, Xiong V, Stark Casadont JM, Mullen TA, Conway N, Baumgardner DJ. Utilization of acupuncture services in the emergency department setting: a quality improvement study. J Patient Cent Res Rev. 2019;6:172-8. 10.17294/2330-0698.1688
April 9, 2019, Medscape article.
“Needles Help with Pain in the ER. No, Not that Kind. (Acupuncture tied to less pain, stress, anxiety)” by Judy George
Video from Wisconsin TV station
Fox6Now. October 10th, 2018. “’It’s great to have an alternative’: Aurora West Allis offering acupuncture in the emergency room” by LeeAnn Watson and Mary Stoker Smith
Medscape article
“Acupuncture in the ED Cuts Pain, Reduces Stress, Anxiety” by Pauline Anderson. Nov. 12th, 2018.
References
Tick H, Nielsen A, Pelletier KR, et al. Evidence-Based Nonpharmacological Strategies for Comprehensive Pain Care. The Consortium Pain Task Force White Paper. 2018. DOI: https://doi.org/10.1016/j.explore.2018.02.001.
Adam S. Reinstein, Lauren O. Erickson, Kristen H. Griffin, Rachael L. Rivard, Christopher E. Kapsner, Michael D. Finch, Jeffery A. Dusek; Acceptability, Adaptation, and Clinical Outcomes of Acupuncture Provided in the Emergency Department: A Retrospective Pilot Study, Pain Medicine, Volume 18, Issue 1, 1 January 2017, Pages 169–178, https://doi.org/10.1093/pm/pnv114
Tags:
#AIHM #AIHM18 #EDacupuncture
Related Blog posts
Consortium Pain Task Force White Paper and the Moving Beyond Medications pdf
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