Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic—an initial report

Gardner, Lucy; Trueman, Hayley

doi:10.1136/bmjoq-2021-001366

Cited by 11 publications

(23 citation statements)

References 9 publications

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“…While it may take time, most patients recognise that reversal of malnutrition is a necessary step towards recovery. The dietetic team was crucial in implementing these changes, helping to manage the patients' distress in the dining room using quality improvement methodology [41].…”

Section: Weight Restorationmentioning

confidence: 99%

Integrated Enhanced Cognitive Behavioural (I-CBTE) therapy can transform outcomes of inpatient treatment for anorexia nervosa in real life settings

Ayton¹,

Ibrahim²,

Ryan³

et al. 2022

Preprint

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Background Inpatient treatment of anorexia nervosa (AN) often results in poor outcomes. To address this, the Oxford service has adapted the multistep enhanced cognitive behavioural (CBTE) treatment model, first developed in Italy, to an NHS setting.Aim: to evaluate short- and long-term outcomes of Integrated CBTE (I-CBTE) with alternative treatment models in routine clinical practice.Methods This is a longitudinal cohort study, involving all adults with AN admitted from a geographical area in England covering a total population of 3.5 million between 2017-2020 using routinely collected data. We compared treatment as usual (TAU) with the Oxford model, which included: 1. short term planned admission with partial weight restoration; 2. I-CBTE (weight restoration defined as BMI 20, combined with 7 weeks day treatment followed by outpatient CBTE); 3. standalone inpatient CBTE. Primary outcome measures (min. 1 year after discharge from hospital) were defined as: 1. good outcome: BMI>19.5 and no binge purging behaviour; 2. poor outcome: BMI<19.5 and/or binge purging; 3. readmission; or 4. deceased.Secondary outcomes were BMI on admission and discharge, and length of stay. Results 212 patients were admitted to 15 specialist units in the UK depending on availability: 120 to Oxford and 92 elsewhere. The mean age: 28.9 (18-60) years, mean BMI: 14.4. There were no significant differences in baseline parameters between patients admitted to different units. Mean discharge BMI was >19.0 in the CBTE groups, 16.0 in the short admission and 17.0 in the TAU groups.At one year follow up, 70% of patients receiving I-CBTE maintained good outcomes, in contrast with <5% TAU or planned short admissions. Readmission rates were 14.3% vs ~60% (χ2=0.0000). Standalone CBTE had intermediate outcomes. The main predictor of good long-term outcome was I-CBTE.ConclusionsOur main finding is that in a real-life setting, I-CBTE has superior short- and long-term outcomes as compared with alternative inpatient treatment models. This was achievable regardless of age, and BMI on admission. Dissemination of I-CBTE across the care pathway has the potential to transform outcomes of inpatient treatment for this high-risk patient population and reduce personal and societal costs.

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Section: Weight Restorationmentioning

confidence: 99%

Integrated Enhanced Cognitive Behavioural (I-CBTE) therapy can transform outcomes of inpatient treatment for anorexia nervosa in real life settings

Ayton¹,

Ibrahim²,

Ryan³

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…The dining room forms an integral part of treatment as a place for patients to work towards restoring a healthy relationship with food. 1 The use of the dining room within the inpatient setting is important because inpatients with AN who restore weight through eating and drinking and reach a healthy body mass index (BMI), together with therapy, achieve better outcomes. 2 As a main treatment approach, the dining room has been reported by patients and staff as a very stressful environment.…”

Section: Problemmentioning

confidence: 99%

“…The dining room forms an integral part of treatment as a place for patients to work towards restoring a healthy relationship with food. 1 …”

Section: Problemmentioning

confidence: 99%

“…This paper outlines the continuation of a quality improvement project, the initial part of which we published in this journal last year. 1 Our aim throughout the project is to understand the system of our dining room, including the environment, purpose and processes and how people interact with these and each other. This will determine how we can make changes to improve mealtimes as a therapeutic intervention to promote recovery.…”

Section: Problemmentioning

confidence: 99%

“…The background to the project and an outline of our first intervention are detailed in the previous report. 1 The initial change idea we introduced was to have a dedicated staff member in the dining room acting in a floating capacity (known as the host role). This reduced the average number of eating disorder behaviours per patient in the dining room by 35%.…”

Section: Introductionmentioning

confidence: 99%

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Improving mealtimes for patients and staff within an eating disorder unit: the next chapter

et al. 2022

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ObjectivesMealtimes are an integral part of treatment for patients in an eating disorder inpatient unit. However, they are often distressing and anxiety provoking for both patients and staff. A consequence of patients’ distress is an increase in eating disorder behaviours specific to mealtimes. This is the second paper detailing a quality improvement project following on from an initial paper outlining the first test of change. The aim of this quality improvement project was to decrease the number of eating disorder behaviours at mealtimes in the dining room through the implementation of interventions identified through diagnostic work.Methods/designThe Model for Improvement was used as the systematic approach for this project. Baseline assessment included observations in the dining room, gathering of qualitative feedback from staff and patients and the development of a form which identifies eating disorder behaviours completed by staff. Interventions in the form of three change ideas have so far been introduced including (1) a host role in the dining room, (2) a guide to the dining room for new staff along with competencies and (3) a dining goals group. The impact of the three interventions is assessed.ResultsThe introduction of the interventions has overall reduced the average number of eating disorder behaviours per patient in the dining room by 33%.ConclusionsThis paper reports the challenges and successes of continuing a QI project through the COVID-19 pandemic and the need for multiple tests of change to improve a complex problem. The results demonstrate a consistent reduction in eating disorder behaviours over a period of nearly 2 years.

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Effects of mealtime assistance in the nutritional rehabilitation of eating disorders

Lacalaprice,

Mocini,

Frigerio

et al. 2023

Eat Weight Disord

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Purpose The aim of the study was to examine the effects of meal supervision, provided by health professionals, volunteers or family members, on anthropometric, nutritional, psychological, and behavioural outcomes in patients with eating disorders (EDs). Methods The present systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The last search was conducted in three databases (PubMed, Scopus, and the Cochrane library). Inclusion criteria considered paediatric and adult patients suffering from EDs, regardless of ethnicity, and treated in different therapeutic settings. The quality of the studies was evaluated using the Newcastle Ottawa Scale (NOS) adapted for cross-sectional studies and Version 2 of the Cochrane risk-of-bias assessment tool for randomised trials. Results 3282 articles were retrieved, out of which only 6 met the eligibility criteria. A marked heterogeneity in definitions and approaches to supervised mealtime was observed. This variability emerged in the methodologies used in the supervised meal, and in the reference values for the outcome measures that were used, such as the analysis of different parameters. Based on these observations, mealtime assistance provided to patients with EDs shows an overall positive effect on eating behaviour and dysfunctional attitudes. Future research should be prompted to provide a thorough definition of a structured procedure for meal assistance to be potentially and systematically included in the nutritional rehabilitation protocols for patients with EDs. Level of evidence Level IV systematic reviews of uncontrolled trials.

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Improving mealtimes for patients and staff within an eating disorder unit: understanding of the problem and first intervention during the pandemic—an initial report

Cited by 11 publications

References 9 publications

Integrated Enhanced Cognitive Behavioural (I-CBTE) therapy can transform outcomes of inpatient treatment for anorexia nervosa in real life settings

Integrated Enhanced Cognitive Behavioural (I-CBTE) therapy can transform outcomes of inpatient treatment for anorexia nervosa in real life settings

Improving mealtimes for patients and staff within an eating disorder unit: the next chapter

Effects of mealtime assistance in the nutritional rehabilitation of eating disorders

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