The Anorexia Nervosa Care Pathway: Closing the Treatment Gap to Improve Care for Patients Admitted to Medical Hospitals

IntroductionMedical complications of malnutrition and refeeding account for approximately half of deaths in anorexia nervosa (AN). The AN Care Pathway (ANCP) was introduced at our institution in 2016 to improve quality of care of patients admitted for medical observation and management. We report results from our review of medical complications and report the impact and adoption of the ANCP. MethodsThe ANCP was developed in response to a need to improve quality of medical monitoring of patients with severe AN using Squire Guidelines and the Plan-Do-Study-Act cycle. All patients admitted to a medical hospital with AN between 2010-2020 were included after hospital inpatient enquiry and medical records were reviewed. Descriptive statistics were calculated using Stata (Statcorp). ResultsFifty-one patients (63 admissions) were included. Median BMI was 13.8 kg/m (11.9-22.5). After ANCP implementation in 2016, compliance with recommended daily ECG, thiamine and blood tests improved from 30% (n=8/27) to 86% (n=21/36). We report a high rate of medical complications of severe AN including anaemia (n=24, 47%), neutropoenia (n=18, 35%), abnormal liver bloods (n=15, 29%) and half developed refeeding syndrome. One-third patients had cardiovascular compromise including reduced cardiac contractility (n=13, 25%), pericardial effusion (n=7, 14%) and one death. Low BMI was associated with cardiovascular complications (mean BMI 13.5 kg/m vs 15.5 kg/m, p=0.01) and neutropoenia (mean BMI 13.4 kg/m vs 15.4 kg/m, p=0.02). ConclusionIntroduction of the ANCP improved quality of care during medical stabilisation. We report a high rate of medical complications of severe AN in patients admitted to a medical hospital. Use of multidisciplinary care protocols may contribute to quality improvement and improved consistency of care for this vulnerable population.