Background: Despite medical advancements for organic and structural diseases, effectively managing acute and chronic functional pain syndromes remains a daunting challenge for hospitalists. Standard inpatient treatments frequently fail to adequately control symptoms, often compelling hospitalists to shift from diagnostics to the contentious task of tapering opioids in patients with legitimate pain. This pivot can lead to professional burnout and underscores the urgent need for innovative strategies in the management of both functional and chronic pain syndromes.
Purpose: This presentation introduces a novel inpatient consultative service offered at UCLA Santa Monica Hospital. This service aims to apply an integrative approach to common inpatient problems, address biopsychosocial contributors to symptoms, and provide non-opioid therapies such as trigger point injections and medical acupuncture, particularly in the context of functional diseases that are refractory to conventional medical management.
Description: The consultative service is situated in a 281-bed tertiary hospital within the UCLA Health system. The service is led by medical doctors (trained in Internal Medicine with additional fellowship training in East-West Medicine) and offers a range of treatments including counseling, acupuncture, and trigger point injections, based on medical necessity. Billing is primarily conducted through Evaluation and Management (E&M) coding, providing a financially sustainable model. A recent study involving 165 unique patients demonstrated that East-West (EW) consultation was associated with a significant reduction in 30-day readmission rates (33.0% vs. 4.6%, p < 0.001, odds ratio [OR] 0.10, 95% confidence interval [CI] 0.06–0.17). This effect was more pronounced when focusing solely on pain-related admissions.In the 3 years since this data was collected, the service has further established itself as integral to the inpatient management paradigm for chronic and functional pain, and has demonstrated operational sustainability with a daily census of 12-25 patients while operating independently of departmental funding or patient fees. Consideration is now being given to expanding this service model to other sites.
Conclusions: The inpatient integrative East-West Medicine consult service at UCLA Santa Monica Hospital offers a promising, financially sustainable approach to managing functional diseases that are resistant to standard medical treatments. The service has demonstrated a significant impact on reducing 30-day readmission rates, and provides a much needed consultation service for inpatient care providers. Further research is warranted to optimize the service and explore its applicability in other medical settings.