An audit of a tool designed to improve the management of young people with eating disorders in the emergency department

Fearn-Smith, Alexandra, Childs, Caroline E., Williams, Sarah and State-Davey, Rachael (2025) An audit of a tool designed to improve the management of young people with eating disorders in the emergency department. Clinical Nutrition ESPEN, 68, 866, [A097]. (doi:10.1016/j.clnesp.2025.03.149).

Abstract

Background: ‘Medical Emergencies in Eating Disorders (MEED): Guidance on Recognition and Management’ (1) was published by the Royal College of Psychiatrists in 2022 following the documented failings of eating disorder (ED) management, resulting in an increased incidence of preventable deaths. Subsequently, an audit undertaken at a large teaching hospital paediatric emergency department (A&E) in 2022 (unpublished data), highlighted several areas requiring improvement regarding ED management, and as a result, a proforma tool of condensed MEED parameters was developed.

Aims: the aim of this audit was to assess the efficacy of, and adherence to, a proforma tool designed to improve the management of children and young people with EDs in A&E, in line with MEED guidelines. Objectives were: to calculate the number of assessments meeting the MEED guidelines; to assess the number of patients who might have been discharged unsafely; to compare the parameters recorded from both audits; and to ascertain if MEED parameter recording improved.

Methods: a retrospective cohort audit of patient notes of children, who presented to paediatric A&E between January - July 2023, with acute food/fluid refusal. The Chi-Squared test for independence and Fishers Exact test were used to assess statistical significance of proforma use and parameters recorded. This audit was approved by the local Ethics Committee (ERGO number 86230).
Results: 41 patients were identified in this audit with 12 having had the proforma used in their notes. Of these 12 patients: 42% met the MEED standard overall, and, none of the 12 were discharged from A&E with any signs of severe ED. Proforma usage statistically significantly improved the recording of 8 parameters (weight loss, % median body mass index (%mBMI), hydration status, Sit Up Stand Squat Test, activity, purging, deliberate self-harm and creatine kinase blood test). In the other 29 patients, 33% were discharged with 2 or more signs of severe ED.

Conclusions: the proforma improves ED assessment by increasing the number of MEED parameters recorded in notes and helping to prevent unsafe discharge. Its effectiveness would be improved by more universal use.
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Contributors

Author: Caroline E. Childs

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