Medical stabilization of adolescents with nutritional insufficiency: a clinical care path

PURPOSE

Nutritional insufficiency (NI) is a potential consequence of restrictive eating disorders. NI patients often require hospitalization for refeeding to restore medical stability and prevent complications such as refeeding syndrome. Limited information is available on the optimal approach to refeeding. In this study, we describe an inpatient NI care path and compare treatment outcomes at an academic medical center and a community hospital.

METHODS

A retrospective chart review was conducted on inpatients treated using a standardized NI care path at either the academic site, from August 2012 to July 2013 (n = 51), or the community site, from August 2013 to July 2014 (n = 39). Demographic information, eating disorder history, and treatment variables were recorded for each patient. Data were compared using the Kruskal-Wallis test and Fisher's exact test.

RESULTS

Patients admitted to the community site had shorter hospital stays than patients admitted to the academic site (IQR 2-4 vs. 2-7 days, p = 0.03). All patients were discharged in <14 days with a median stay of 3 days. The median initial calorie prescription was 2200 calories for both groups. No clinical cases of refeeding syndrome occurred, with only one patient developing hypophosphatemia during refeeding.

CONCLUSIONS

A standardized care path with a higher-calorie intervention allows for short-term hospitalization of NI patients without increasing the risk of refeeding syndrome, regardless of treatment site. This study demonstrates the efficiency and safety of treating NI patients on a regular medical floor at a community hospital.

Effectivenes of a track-based model for treating eating disorders in a general psychiatric hospital

Due to comorbid disorders or the degree of severity of their eating disorder, individuals may not warrant treatment at a specialty eating disorder facility. This article examines the effectiveness of a track-based model for treating eating disorders at a general inpatient psychiatric hospital. One hundred seventy-six patients who participated on the Eating Disorder Track and completed the Eating Disorder Inventory-3 (EDI; Garner, 2004) were examined to determine whether their eating disorder symptoms improved over the course of their treatment. Results indicated that patients significantly improved across all eating disorder risk scales and psychological scales measured by the Eating Disorder Inventory. This suggests that patients who may not meet the criteria for attending a specialty eating disorder program may receive an alternative form of treatment for their eating disorder that is effective in reducing their eating disorder symptomatology. The hope is that providing more treatment options will expand the reach of eating disorder treatments to more individuals who need specialized care for these disorders.