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75 Evaluation of emergency department risk assessment completeness in adolescents with known or suspected eating disorders – a single-centre observational study
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75 Evaluation of emergency department risk assessment completeness in adolescents with known or suspected eating disorders – a single-centre observational study
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75 Evaluation of emergency department risk assessment completeness in adolescents with known or suspected eating disorders – a single-centre observational study
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Journal Article
75 Evaluation of emergency department risk assessment completeness in adolescents with known or suspected eating disorders – a single-centre observational study
2023
Overview
ObjectivesEating disorders are common with a peak onset occurring in adolescence. Concerningly, they have the highest mortality of any psychiatric illness from suicide or medical complications.Medical Emergencies in Eating Disorders (MEED) guidelines were developed following a high-profile report demonstrating failures to recognise deterioration.1 2 Presentations to the emergency department provide an opportunity for risk assessment and intervention.This study aimed to assess the completeness of risk assessments undertaken for adolescents attending the emergency department with complications related to suspected or known eating disorders.MethodsRetrospective cross-sectional study at a single emergency department (03/12/21 – 30/11/22).Adolescent patients (10.0–15.9 years) with a known or suspected eating disorder were included. The completeness of assessment for each risk factor was compared against the MEED guidance.1 Data were collected on demographics, attendance details, and individual risk factors.Relevant attendances were identified by screening by attendance reason (loss of appetite, weight loss, hypoglycaemia) and then manually reviewing these for relevant attendances. Data were extracted from the electronic medical record (Epic Hyperspace Production®) and analysed using Microsoft Excel. Data are reported as number (percentage), and median [inter-quartile range].Results17 emergency department attendances from ten patients were included. All patients were female, and the median age was 15.0 [11.5–15.0] years. An eating disorder was known in 12/17 (70.6%) and suspected in 5/17 (29.4%) of attendances. Most attendances were self-referrals (10/17 (58.8%)), 6/17 (35.3%) were referred from the community, and 1/17 (5.9%) attended via ambulance. The median duration of stay in the emergency department was 217.0 [151.5 – 278.5] minutes.A complete risk assessment was undertaken in 4/17 (23.5%) of attendances. All complete assessments had documented reference to guidance, and overall 7/17 (41.2%) of attendances had guidance referenced. Risk factors that were most frequently not (or incompletely) assessed were: self-harm and suicidal ideation (9/17 (52.9%) complete), purging behaviours (8/17 (47.1% complete), muscular function (4/17 (23.5% complete), and ECG abnormalities (8/17 (47.1%) complete), table 1. Over two-thirds (12/17, 70.6%) of patients were admitted, and those who were discharged all received documented discharge advice or follow-up appointment, either with Children and Adolescent Mental Health Services (CAMHS) or their General Practitioner.ConclusionA complete risk assessment for adolescents attending the emergency department with an eating disorder was observed in less than a quarter of presentations. An increased awareness of MEED guidance may help to improve this.ReferencesRCPsych. Medical Emergencies in Eating Disorders: Guidance on Recognition and Management. RCPsych College Report [CR233]. 2022. Accessed online at https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2022-college-reports/cr233PHSO. Ignoring the alarms: How NHS eating disorder services are failing patients. Parliamentary and Health Service Ombudsman. 2017. Accessed online at https://www.ombudsman.org.uk/sites/default/files/page/FINAL%20FOR%20WEB%20Anorexia%20Report.pdfAbstract 75 Figure 1[Image Omitted. See PDF.]
