Person-centred care in an age of protocols: a qualitative study of the management of medical admissions for eating disorders using the Medical Emergencies in Eating Disorders guidelines

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OBJECTIVE: As an emergent secondary analysis of a wider qualitative study, we aimed to understand how paediatricians apply the Medical Emergencies in Eating Disorders (MEED) guidelines in relation to recommending nasogastric tube feeding under physical restraint. SETTING: Paediatric wards in England. METHODS: We recruited clinicians working in acute paediatric settings in England via adverts using three professional networks. Participants were from a variety of professions within the multidisciplinary team involved with caring for those with an eating disorder. Individual interviews using semistructured interviews were conducted. The interviews were recorded and transcribed by Microsoft Teams and checked for accuracy. This secondary analysis applied Braun and Clarke's approach to thematic analysis. RESULTS: 20 participants (five males and 15 females) were recruited across 15 National Health Service Trusts. Overlapping themes between participants identified three main themes of 'positives of MEED', 'negatives of MEED' and 'learning how to use MEED well'. Subthemes of 'tolerating risk', 'individualised meal plans', 'second opinion', 'more time' and 'teamworking' were identified. CONCLUSIONS: This research identifies that paediatric clinicians find the MEED guidelines helpful in understanding who needs to be admitted. Additionally, participants reported their learning on how to make these admissions more successful through personalisation of treatment planning.

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