Quality improvement project: comorbid eating disorders during psychiatric inpatient hospitalization

Abstract

Background. Eating disorders (ED) are the second leading cause of psychiatric deaths. Children and adolescents with psychiatric disorders are at an increased risk of comorbid ED. Local Problem. A pediatric psychiatric inpatient hospital has a reputable psychiatric inpatient program; however, the subspecialty of EDs is less established at the facility. Thirty-one percent of admissions over 12 months had positive ED screening results. Methods. This quality improvement (QI) project identified areas to improve communication and transitions of care using the Donabedian model, which focuses on structure, process, and outcome. The QI project was implemented over a seven-week timeframe, utilizing nursing, medical, and non-nursing professionals. Implementation. The QI project developed process modifications to increase the transition of care pathways, communication, and overall ED awareness. Four means of process changes involved the development of a community ED resource list, anticipated aftercare needs, documentation of positive ED screening results from admissions to the inpatient unit, registered dietitian referral, and anticipated discharge needs for follow-up care. Results. Over the QI seven-week timeframe, 42.6% of the psychiatric hospital admissions had positive ED screening. The process change compliance was strongest with nursing and family nurse practitioner staff. The anticipated aftercare needs and use of ED discharge follow-up provided limited data. Conclusion. More pathways need to be established to support comorbid ED care in the inpatient psychiatric setting and transition to outpatient care. The results identified further gaps consistent with current literature, which focuses on validated ED screening tools, barriers to implementation, routes of communication, and roles of PCPs. Comorbid EDs are complex and elusive, requiring treatment pathways to increase awareness, screening, communication, and support during transitions of care.