O44 Raising awareness of medical emergencies in eating disorders: a quality improvement project

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Introduction Eating disorders (ED) are complex psychiatric illnesses and can be associated with high mortality rates, due to complications of malnutrition.1 The Medical Emergencies in Eating Disorders (MEED) guidelines support early recognition of these life-threatening medical complications.2 An initial audit within our trust recognised that these guidelines were under-utilised, with only 10% of patients receiving a comprehensive assessment on admission to hospital. It was therefore acknowledged that there was need for increased awareness. Methods Our initial audit assessed all patients admitted to the trust between 1st April 2024- 31st March 2025 with a known ED diagnosis. Health records were reviewed, focusing on completion of MEED assessment. A visual aid ‘checklist’ was generated and demonstrated, alongside education on MEED, to acute medicine and gastroenterology departments. The checklist was designed to support staff on the acute take, and base wards, to complete a comprehensive assessment of risk, recognize life-threatening complications of ED, and initiate basic management. A repeat audit was carried out to assess any improvement in the utilisation of MEED guidelines, in patients admitted from 1st June 2025 to 1st December 2025. We also assessed if patients had a ‘partially completed’ assessment, which was defined, as a management plan, including at minimum: assessment of weight, blood tests, ED-related behaviours and suicidality/self-harm. Results Post intervention, a total of 16 adults were admitted with an ED over a 6 month-period. 81% of these patients were female, and the average age at admission was 38.9 years. The most common underlying ED was Bulimia Nervosa, followed by Anorexia Nervosa, and ED NOS. MEED assessments were fully completed in 13% of patients (increased from 10% in Cycle 1), and an assessment was ‘partially completed’ in 50% of patients (increased from 28%). The remaining 6 patients (37%) had no MEED assessment completed. The most common reason for admission was hypokalaemia. Conclusion Our project has shown that the introduction of a visual aid checklist appears to have improved awareness of MEED, to some degree, and increased the number of patients having an assessment completed on admission to hospital. Conversely there are still a large number of patients who did not have assessments done, highlighting that further work is needed. Our future work will look to engage with our local eating disorder services to support better implementation of guidelines and develop targeted interventions. We are hoping to explore the creation of a standardised MEED electronic form to improve documentation, as although a visual aid has been helpful, this may increase completion rates further. In parallel, we will continue to deliver teaching sessions to improve confidence in identifying and managing medical risk in ED presentations. References Franko DL, Tabri N, Keshaviah A, et al. Predictors of long-term recovery in anorexia nervosa and bulimia nervosa: data from a 22-year longitudinal study. Journal of Psychiatric Research 2018;96:183–8. Royal College of Psychiatrics. 2022. Medical emergencies in eating disorders (MEED). Available at: https://www.rcpsych.ac.uk/improving-care/campaigning-for-better-mental-health-policy/college-reports/2022-college-reports/cr233

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