key phrases: interview, acupuncture programs, acupuncture for acute pain, acupuncture in the ER, examples of incorporating acupuncture into healthcare systems and hospitals
Who: John Burns, DPT, MSOM, Manager of Acupuncture
at Aurora Health Care, Milwaukee, Wisconsin
Organization: Advocate Aurora Health Care
Location: Milwaukee, Wisconsin and surrounding suburbs
What: Providing services in 11 oncology clinics, 7
OP clinics, 1 ED, 2 IP
 |
Dr. Burns with his poster at the AIHM conference. #AIHM18
photo credit Megan Gale |
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 #AIHM18 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.
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.
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
 |
Dr. John Burns awarded first place of the
AIHM 2018 posters.
photo credit Megan Gale |
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.
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)
·
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 29th, 2019, in the peer-reviewed scientific journal, Journal of Patient-Centered Research and Reviews (JPCRR). See reference section below for citations and links.
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 of 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.
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
How do they sustain the program?
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.
Part 4: References
Contact
information for Dr. Burns and the Aurora Acupuncture Program
Links to related publications
on the Aurora ED Study
- April 2019 updates
- Video from Wisconsin TV
station, Fox6Now.
- Medscape article
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
Related Blogposts
Videos highlighting the Aurora integrative medicine program
Tags: #AIHM #AIHM18 #EDacupuncture
Advocate Aurora's Oncology Acupuncture and Integrative Therapies Program (update Oct 2020)
- New* in Sept 2020, published in JACM, with information on Advocate Aurora's (Wisconsin) oncology acupuncture and massage therapy programs. "A Quality Brief of an Oncological Multisite Massage and Acupuncture Therapy Program to Improve Cancer-Related Outcomes" by Jennifer Fink, John Burns, Ana Christina Perez Moreno, Jessica J.F. Kram, Melissa Armstrong, Sara Chopp, Scott J. Maul, and Nancy Conway. The Journal of Alternative and Complementary Medicine (JACM), Sept 2020. 822-826. https://doi.org/10.1089/acm.2019.0371.
- More on the topic of oncology acupuncture programs and defining "success" at this post.
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 |
| www.thehospitalhandbook.com/support-the-project/ |
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
