Background: Approximately 20 million females and 10 million males in the United States have a clinically significant eating disorder at some point in their lifetime. In Western New York, comprising the three largest cities of Buffalo, Rochester and Syracuse, there are about 29,000 persons with eating disorders. Unfortunately , treatment for these medically fragile patients is limited, especially in the adult population. Most efforts have been towards adolescents. Currently, throughout the country, patients can be treated as an outpatient, partial hospitalization or residential. If a patient becomes medically unstable, the only option to date has been ICU level treatments for specialized eating disorder management.
Purpose: And adult eating disorder program has been developed to care for adult patients with active eating disorders who are too medically ill to be treated on an outpatient basis . The goal is for medical stabilization, initiation of treatment for the eating disorder and coordination of resources to establish a successful transition of care to lower level treatment (residential, partial, outpatient).
Description: The adult eating disorder program is a multidisciplinary collaboration initiated in 2018, with cohorting of patients on one inpatient medical unit. The current adolescent medicine protocol at the Golisano Children’s Hospital was used as a basis and was modified to treat the adult population, which included modification from a 17-day to a 14-day protocol. Initiation required intensive education for nurses, social workers, registered dietitians and providers to this patient population and the protocol. Patients are referred to the inpatient treatment by outside providers, with referrals from the thirty counties that are covered under the Western New York Comprehensive Care Center for Eating Disorders. Once admitted, these patients are enrolled in the protocol, which includes screening for medical complications of an eating disorders. It also involves strict monitoring of intake/output, daily blinded weights, monitoring orthostatic vital signs, electrolytes with replacement as needed, activity monitoring, bowel maintenance , meal planning and support, monitoring for food avoidance or diversionary tactics and education. Given the early nature of the program, rounding is with both the Adult Hospital Medicine team and Adolescent Medicine. All patients are screened by the Prime Team (Proactive Integration of Mental Healthcare in Medicine) to detect psychiatric co-morbitidies and to provide consultation, as necessary. As the protocol progresses, family members/support persons are folded into education with onsite and then 4-hour day passes for demonstrating/practicing of acquired skills.
Conclusions: This program is the first of its kind in the country, and it provides care and treatment for some of the most vulnerable and sick patients. To date, approximately fifty patients , male and female, ages 19 – 60 have been through the program. In addition to providing optimal care, this latest year has also some unmasked questions and issues that previously were not well recognized. These included ethical and legal issues, such as decision-making capacity and lack thereof; refusal of care and how that impacts treatment; need to modify the protocol per patient, depending on their medical stability and support system; as well as the need to educate people not directly involved in patient care, such as environmental service workers, to avoid making unintended, inappropriate comments to the patient.