Article Title

Utilization of Acupuncture Services in the Emergency Department Setting: A Quality Improvement Study

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Abstract

Background: Patients often present to the emergency department (ED) for pain. As opioid fatalities rise, alternative treatments in the ED are warranted for pain management. Acupuncture, a nonpharmacological treatment involving the insertion of needles into skin or tissue at specific points within the body, may help to decrease acute pain experienced by patients seeking ED services.

Purpose: To assess the utilization and impact of acupuncture in the ED setting for pain management.

Methods: We conducted a prospectively designed and retrospectively reviewed quality improvement study. Patients ≥ 18 years old who presented to the Aurora West Allis Medical Center ED (West Allis, WI) during 2017 were offered acupuncture services from an acupuncturist based on their emergency severity index score (highest severity [1] – lowest severity [5]), reason for visit, and, ultimately, their physician’s recommendation. Charts were further reviewed for other demographic and visit characteristics. Demographic characteristics were described using basic summary statistics. Wilcoxon signed-rank tests were used to determine differences in pre- and postacupuncture pain, stress, anxiety, and nausea scores (ie, no pain [0] – worst pain [10]).

Results: A total of 379 patients, mean age 47.5 years and mean body mass index 30.8 kg/m², received acupuncture services. Patients were predominately female (68.1%) and non-Hispanic white (77.0%) and presented with an emergency severity index score of 3 (68.9%) or 4 (24.8%). Following enrollment, patients had 8–15 needles placed (86.0%) and received either 20 or 30 minutes of needle time (92.6%). Median pre- and postacupuncture pain (7.0 vs 3.0), stress (7.0 vs 0.0), and anxiety (5.0 vs 0.0) scores were significantly different (P < 0.001). Differences in median pre- and postacupuncture nausea scores were not significantly different, as most patients reported no nausea preacupuncture (70.7%). Overall, patients mean length of stay in the ED was 194 minutes, with 10.6% of patients admitted to the hospital. Only 2.1% of patients presented to the ED twice within 24 hours, and none received acupuncture services more than once. Following discharge from the ED, < 2% received acupuncture services within 30 days.

Conclusion: Patients admitted to the ED experienced significant decreases in pain, stress, and anxiety. It is unknown whether this decrease was due to acupuncture therapy and not the synergy between opioid and acupuncture use. Ultimately, while further study is warranted, acupuncture may be an alternative treatment to opioid use during the ED admission.