Aims To describe how a brief (7-10 day) medical stabilisation model was developed for young people with restrictive eating disorders through joint team building between paediatrics and Child and Adolescent Mental Health Services (CAMHS). The paper will outline development of the team across traditional mental and physical health boundaries, challenges faced, outcomes, and discuss benefits of the model for patients, families, Trusts and the wider health economy.
Methods From 2014-2015 a consultant psychiatrist and paediatrician worked to turn existing informal support into a formalised arrangement, aligning with regional CAMHS transformation. This led to development of a multidisciplinary regional Tier 3 community eating disorders service (CYP-CEDS). From 2015-2016 work began with children’s nursing staff in the local paediatric unit to develop skills in managing young people with eating disorders. Concurrently, a multidisciplinary team across paediatrics and mental health worked on development of a shared protocol. From early 2016, young people were selectively admitted to the paediatric ward for medical stabilisation if required, with primarily nurse-led management and supervision and liaison from the CYP-CEDS.
Results 61 patients had a total of 72 admissions over three years. Age range 10-17 years (mean 14.8 years). Length of stay range 1-22 days, with mean of 9.7 days in year 1, 10.4 days in year 2 and 7. 2 days in year 3. Of admissions from the community, 79% (50/63) were discharged back to the CYP-CEDS. 82% of admissions (59/72) were managed entirely with oral feeding on the ward. 4% (3/72) had a brief period of nasogastric (NG) feeding but were discharged orally feeding. Over the 3 years, the rate of admission to a Tier 4 eating disorders inpatient unit fell from 14% of CYP-CEDS caseload in year 1 to 4% of caseload in year 3. Challenges faced included: training, including in ethicolegal aspects; risk management; nursing rotas; avoidance of parental disempowerment.
Conclusions With effective joint working between physical and mental health and upskilling of children’s nursing staff, young people with severe eating disorders can be effectively stabilised and eating established over only 7-10 days on a paediatric ward. This has led to significant reduction in admission to inpatient psychiatric units, with less time in hospital overall and reduced system costs.
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