P0296 - Perspectives on Acupuncture in the Pediatric Emergency Department

Background: The opioid crisis catalyzed a national drive to better utilize non-pharmacologic pain management. To our knowledge, no study has examined staff, parent, or patient perspectives on acupuncture implementation in pediatric emergency departments (PED).

Objective: To understand staff, parent, and patient attitudes and barriers related to PED acupuncture.

Methods: We conducted 2 studies at 2 PEDs within a single children’s health system (125,000 visits/year). In Study 1, English-speaking patients (12-18 years), parents, and ED staff (child life specialists, nurses, physicians) completed anonymous surveys exploring factors associated with acceptability of PED acupuncture and barriers to acupuncture utilization. Responses were assessed using Chi-square and Fisher’s exact tests, employing a 3-point Likert scale for parent/patients (not at all likely/somewhat likely/very likely) and 4-point scale for staff (never/not likely/likely/very likely).
In Study 2, the 22 PED physicians credentialed in 2 acupuncture protocols completed monthly anonymous surveys with free-text responses regarding acupuncture successes and barriers to acupuncture implementation. Data was analyzed using thematic analysis.

Results: 182 PED staff participated in Study 1 (response rate 73%; Table 1). Majority were likely/very likely (92%) to have acupuncture performed on their patients. Personal experience with acupuncture and being credentialed in basic acupuncture were significantly associated with favorability (p<0.001 and p=0.005 respectively). Perceived barriers to providing acupuncture in the PED were parent and patient willingness (30.8%), patient flow (29.7%), and lack of trained physicians (16.5%). PED site, staff role, and length of practicing medicine were not significantly associated with staff willingness to have acupuncture performed.
116 patients and 124 parents participated in Study 1 (Table 2). 88% were somewhat/very likely to try acupuncture in the PED. More parents responded they were very likely (47%), compared with patients (27%) (p=0.001), although 54% of patients reported they were somewhat likely to try acupuncture. Prior awareness of acupuncture was associated with increased likelihood of trying acupuncture (p=0.005). Participants’ likelihood of trying acupuncture was inversely related to perception of pain from acupuncture needles (p=0.002). Most patients and parents (60% and 73% respectively) were willing to add 15-60 minutes to their ED length of stay to complete acupuncture.
50 physician responses were analyzed in Study 2. Themes around successes with PED acupuncture implementation were improved patient-reported pain in the ED and possible prevention of pain recurrence. Themes around barriers included provider time, patient flow, patients’ anticipatory anxiety, patients’ condition improving with medicines, and limited volume of patients with complaints deemed appropriate for acupuncture.

Conclusion: Most staff, parents, and patients reported willingness to use acupuncture in the PED. Qualitative data from physicians performing basic acupuncture in the PEDs found patient and systems factors as barriers to implementation. Future studies should explore acupuncture implementation and efficacy in the PED setting.