Improving care for patients with severe eating disorders in a university hospital without a formal eating disorder service

Eating disorders affect 1%-4% of the population and anorexia nervosa has the highest mortality rate of all mental disorders. Medical Emergencies in Eating Disorders guidelines guide the management of severely medically unwell patients with anorexia nervosa who require medical admission. Locally, incidents had raised concerns around deviations in care locally from guideline-based care, and we aimed to improve care and seek full compliance with guidelines.The management of patients with severe eating disorders in the past year at our hospital was evaluated, and the Hospital Information System was interrogated for patients with eating disorders who might not have been identified clinically. In consultation with staff, a pathway was agreed to optimise identification and treatment of eating disorders in patients presenting to hospital. We developed a resource pack to guide care and delivered education to relevant clinical areas: emergency department, general medicine and psychiatry, including using simulation-based training where appropriate.Concordance with guideline-based care rose from 27% prior to this intervention to 100% afterwards. Each new patient with a suspected eating disorder represented a new plan-do-see-act cycle, allowing development of the project with each episode of patient care. There was an improvement in overall confidence in the identification and management of eating disorder in the hospital.This process highlighted that implementing a small change in patient care requires extensive consultation. The patient story was key to engaging stakeholders as it illustrated the impact on the individual patient. At 6-month follow-up, six patients have been treated via the pathway. These numbers may seem small, but this is a rare condition with a high mortality rate, and there is no room for error. The project has improved the management of patients with severe eating disorders in the general hospital setting.