Developing Inpatient Services

The range of eating disorder service options needed across the health system can be conceptualised in terms of increasing specialisation and intensity with flexible patient flows supported by collaborative care planning.

Service configurations and linkages may vary on the basis of developmental considerations, geographic and resource constraints, but will need to consider:

Acute and emergency responsiveness:

  • Emergency Departments have a key responsibility in facilitating entry into treatment. [Please see Guidelines for the Inpatient Management of Adults with Eating Disorders and the MHKids Toolkit below as these documents contains information about thresholds for treatment and admission and guidelines around interventions appropriate to the ED context. The NSW Health Red Book also contains limited information about presentations by people with eating disorders].
  • Local Emergency Departments, medical, psychiatric or paediatric wards need to be able to identify illness or significant risk and be equipped to provide medical stabilisation and/or acute intervention.
  • People with anorexia nervosa should be able to access medical beds where their BMI is 14 or under. Earlier admission is desirable to halt the illness trajectory, reduce length of stay and disease impact.

Model of Care to support essential treatment:

  • Liaison and interface between medical and mental health care, to treat aspects of the illness and prevent mortality, is essential.
  • Involuntary admission and treatment through the application of the NSW Mental Health Act is appropriate and may be required when there is significant risk of harm. However, voluntary engagement of the person in recovery planning is necessary and imposed treatment should be applied judiciously and reflect individual stage of readiness for change.

Access to specialist consultation and care planning:

  • Local Hospitals/ District Hospitals need access to specialist advice and consultation in developing care plans including for safe refeeding, psychiatric and mental health care, nursing management, dietetic and behavioural interventions.

Guideline Documents

pdficon_small DOWNLOAD Guidelines for the Inpatient Management of Adult Eating Disorders in General Medical and Psychiatric Settings in NSW.

This document is designed to be used by Nurses, Doctors, Allied Health and general health staff located in hospitals or wards without specialist eating disorder facilities, to guide in the assessment of people with eating disorders, indicators for admission, and management strategies. Please note, the guidelines are an appendix to the NSW Service Plan for Eating Disorders document.

pdficon_small DOWNLOAD MH-Kids Eating Disorders Toolkit: A Practice-Based Guide to the Inpatient Management of Adolescents with Eating Disorders, with Special Reference to Regional and Rural Areas.

The Eating Disorders Toolkit is a practice-based manual that aims to assist health professionals in applying best-practice principles in non-specialist inpatient settings in NSW. The Toolkit aims to assist with improving access to practical information, to facilitate consultation with specialist staff and to improve consistency in care for adolescents with eating disorders across NSW.

The document has been developed with the busy clinician in mind, aiming to ensure easy access to relevant information. A clinician who is new to the management of eating disorders may find the Toolkit an invaluable resource of background information essential to the management of adolescents with an eating disorder.

Setting limits and boundaries in an in-patient setting

In the video below, Credentialed Mental Health Nurse Peta Marks explains the essential components of setting limits in an inpatient setting. Limits may be in relation to eating behaviours, foods or amounts; around exercise or activity; around purging, bed rest or other aspect of inpatient treatment.

 

 

Read the evidence

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   LINK TO: Nicholls, D., Hudson, L., Mahomed, F., (2011)  Managing anorexia nervosa. Arch Dis Child. 2011 Oct;96(10):977-82.   doi:10.1136/adc.2009.177394

This is a detailed overview of the medical management of children and adolescents with anorexia nervosa. Topics covered include: nutritional assessment, management of patients at acute risk, re-feeding and managing long-term growth and development.

 

Web-Google-alt-1-Metro-icon   LINK TO:  Hudson, LD., Court, A.J. (2012) - What paediatricians should know about ED in children and young people. J Paediatr Child Health. 2012 Oct;48(10):869-75. doi: 10.1111/j.1440-1754.2012.02433.x

This is an insightful guide for paediatricians and other health professionals involved in caring for children and adolescents with an eating disorder. Provides a detailed discussion of the assessment and management of underweight children and adolescents, including medically unstable underweight individuals.

 

Corbett 2012 - Eating disorders: The dietitians role in a CAMHS setting. Nursing in General Practice. 

This is an informative guide for health professionals working in an in-patient facility involved with the care of children and adolescents with an eating disorder. Nutritional management and assessment of young people with disordered eating is covered in depth.

 

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   LINK TO:  Mehler, P.S., (2003) Bulimia Nervosa. N Engl J Med 2003; 349:875-881  doi: 10.1056/NEJMcp022813

This is a very useful article providing clinical recommendations for the treatment of a patient with bulimia nervosa, structured around a case study of a young adult female who reports bingeing and purging several times a day. The medical complications of bulimia, the management of medical complications, and psychiatric management (include psychotherapy and pharamacotherapy) are discussed.

 

Web-Google-alt-1-Metro-icon  LINK TO:  Mitchell & Crow (2006) – Medical complications of AN & BN. Current Opinion in Psychiatry, 19(4):438-443 doi: 10.1097/01.yco.0000228768.79097.3e

This is an overview of particular areas of concern regarding the medical complications of anorexia nervosa and bulimia nervosa. These include complications with the skin, the endocrine system, the gastro-intestinal system, the cardiovascular system, the skeletal system, leptin, metabolism, nutrition and mortality.