Guidance for Use of Pre-Admission and Discharge Checklists where the next admission will be at least the third admission in three years.

 

  1. The clinical Commissioner / case manager will identify a referral with a potential third (or more) admission in three years.
  2. ​​​​Clinical commissioner will contact SEDU and referrer, ask if there is a rationale for considering admission to a different SEDU, and if not, arrange pre-admission meeting to review the ‘Before Admission’ section of the preadmission checklist.
  3. At subsequent CPAs consider ‘During admission’ and ‘Family involvement’ sections of the checklist.
  4. As discharge planning begins, move to reviewing the ‘Discharge Checklist for people with multiple admissions’.

 

Readmission Checklist

To be used in a pre-admission planning meeting and CPAs for people who will be admitted for at least their third admission in three years

Before Admission

Consider whether benefits of a different SEDU outweigh benefits of continuity in their host SEDU

 

Review lessons and effective approaches from previous admissions

 

Consider different target BMI or length of admission

 

Arrange preadmission aims planning meeting with SEDU, CEDS, individual and family, including target length of stay and wider goals

 

Ensure handover of psychological work and formulation from community to SEDU

 

Consider reflective practice slots with inpatient staff to name and address feelings about re admission and holding hope

 

Provide preadmission pack to service user

 

Provide family support pack

 

During Admission

Ensure treatment of co-morbidities is optimised (medication, psychological and rehabilitation work with Occupational Therapy)

 

Ensure adjustments to accommodate ASC are made if appropriate

 

Discuss recovery stories with person and reasons why this admission could be different

 

Consider financial position and whether a benefits review is required

 

Ensure OT work to focus on developing skills and interests to develop roles outside of the eating disorder

 

Consider psychological work on identity outside eating disorder

 

Family Involvement

Actively promote the involvement of family and friends, working through barriers and resistance to this, unless there are specific disadvantages

 

Consider providing specific advice  and training to family, particularly around practicalities and challenges of mealtimes

 

Ensure family perspective is gained and incorporated in care plan

 

Signpost family to external support

 

Ensure Empowered communication template is followed

 

If available, has family therapy been offered?

 

Ensure all barriers to recovery are addressed even if not present on SEDU eg

  • Planning for eating at work / school /college
  • Ability to attend appointments
  • Other barriers which may affect engagement in treatment and/or recovery

 

 

Click here to download

Pre-Discharge Relapse Prevention Checklist

To be used in the discharge CPA for individuals with at least 3 admissions in 3 years

This document aims to ensure holistic discharge planning has occurred collaboratively between SEDU, CEDS and the person being discharged to promote recovery and avoid the need for further admissions.

 

Have the CEDS, SEDU and service user reflected on previous discharges, and periods of leave, to inform final discharge plan /package?

 

Have necessary referrals been made to ensure support is ready on discharge, including for co-morbid conditions?

 

Have intensive community support options been considered?

 

Has the community team informed SEDU and service user of any change in community care team compared to prior to admission?

 

Have there been periods of home leave with review by community team to ease transition?

 

Has the Empowered communications template been followed?

 

Ensure handover of psychological work and formulation from the SEDU to the community team

 

Does the service user have the necessary resources to allow them to engage with the plan (e.g. means of travelling to appointments)

 

Is there evidence the current psychological approach is effective or that an alternative approach may be beneficial?

 

Has wider support on discharge e.g. charities, housing, social, education been considered?

 

Has the plan for family involvement in the community been agreed by all?

 

Have the family been offered carer support?

 

Would it be useful to identify threshold for readmission?

 

Has a discharge pack been offered?

 

 

Click here to download checklist

We are aware that the checklists and associated pre-admission meeting will require an additional time commitment, however, the high threshold of three admissions in three years mean this is will only be used for a small group of people who are most likely to benefit from this additional planning.

If desired, it is entirely acceptable to also use the checklists for other people, for example if previous admissions have been particularly long, difficult or of limited value. This is at the discretion of the clinicians involved.

 

If there are any suggestions about amendments to either checklist, please contact Duncan Campbell - Head of Clinical Commissioning for Empowered.

Empowered will initially use the Checklists for one year, and will review their ease of use and efficacy in September 2026.