Admission to a Specialist Eating Disorder Unit has substantial disadvantages for the individual due to disconnection from their family and friends. Treatment in the community is therefore normally preferable except when;

  • Physical health is significantly compromised

It is widely accepted that admission to a SEDU should be reserved for those patients who are physically compromised, and their physical health risk is a challenge to manage in the community.  This could include (but not limited to):

  • Poor mobility/weakness secondary to the eating disorder
  • Electrolyte imbalance
  • High risk of refeeding syndrome
  • Dehydration
  • Abnormal blood results (severe anaemia, low white cell count etc)
  • Abnormal ECG (profound bradycardia, prolonged QTC interval)
  • Rapid rate of weight loss

Whilst there are no minimum or maximum BMI thresholds for admission, it is generally not in a patient’s best interest to be admitted to a SEDU with a BMI > 15 as this can normally be managed in the community.  There may be occasional circumstances when this does not apply, particularly if a patient is physically compromised (see above).

Patients under a BMI of 13.5 will be at higher risk of serious medical complications.  There should be consideration into whether a patient needs stabilisation on a medical ward before admission to a SEDU.  This should be discussed with the SEDU before the referral is made, to clarify whether more appropriate treatment is delivered in a medical setting in line with MEED guidance.  The need for this referral discussion between SEDU and Community Providers should not delay a medical admission if this is required.

  • Poor response to community transfer

There may be occasions when individuals, whose physical health is not acutely compromised, would benefit from inpatient treatment to avoid a chronic course of illness. This group of people will still have a severe eating disorder, which has compromised physical health to a degree.  Individuals should have engaged with an appropriate trial of treatment as an outpatient, including multidisciplinary reviews, to ensure that alternative community interventions have been considered.

  • Symptom Interuption

In exceptional circumstances it may be appropriate to admit a patient suffering from severe and medically unstable Bulimia Nervosa for a symptom interruption admission, e.g. a patient with diabetes, pregnancy, or not responded to intensive community treatment.

  • Psychiatric comorbidity is not an exclusion criterion. 
  • However, whilst it is accepted that patients with eating disorders will present with psychiatric comorbidity, consideration needs to be taken into the primary disorder and whether admission to a SEDU is likely to be detrimental to the patient (for example in EUPD, abnormal illness behaviour, autistic spectrum disorder).  This will require careful consideration into balance of needs, best interests of the patient, previous experience of SEDU admission, and possible more appropriate signposting to alternative inpatient or community treatment.
  • It will be of particular importance, when considering admission for people with severe psychiatric co-morbidity, to consider whether admission could be avoided if community treatment of the co-morbidity could be optimised

 

  • Fully mobile
  • Positive weight trajectory
  • No evidence of refeeding syndrome after adequate challenge of increased nutrition
  • No overt abnormalities in blood results
  • Stable blood glucose
  • No requirement for intravenous treatment (fluid, electrolytes)
  • NEWS 3 or less

Inclusion Criteria (Criteria which are felt all units should meet. Criteria can be used flexibly where clinically necessary)

  • 18 plus (there may be some flexibility if a patient is approaching 18.  This will be considered on a case by case basis following discussions with referrer    and other appropriate stakeholders)
  • Any gender
  • Any diagnosis
    • All units expected to take patients with BMI of 10 or greater – however, MEED guidance states that patients with BMI <13.5 should initially be treated in a medical setting for physical stabilisation.  Admission for a patient with BMI <13.5 direct to a SEDU will require careful consideration of risks versus benefits alongside discussion with community providers.
  • Patients who are under section (Mental Health Act)
  • Patients requiring Naso-gastric feeding

 

Exclusion Criteria (Criteria which are felt to be acceptable grounds for declining an admission)

  • Significant risk of violence to others
    • If patient is severely and / or acutely unwell that is beyond the ability of the SEDU to manage. This is likely to include patients with BMI <12 but may also include patients with higher BMI.
  • BMI less than 10