Emergency Medical Reviews and Medical Admission Transfers During Psychiatric Inpatient Eating Disorders Unit Treatment

Abstract

Objective: There is limited information regarding emergency medical reviews (EMRs) and medical admission transfers for psychiatric eating disorders inpatients. We aimed to describe (i) EMRs during psychiatric inpatient eating disorders treatment at the Eating Disorders Unit (EDU), Austin Hospital in Melbourne, Victoria, and (ii) medical admission transfers during EDU admissions.

Methods: Retrospective review of patient files was undertaken for inpatients aged 18 – 65 years with an eating disorder who resided within the Body Image & Eating Disorders Treatment & Recovery Service (BETRS) catchment area and were admitted to EDU between 01/01/21 to 30/10/23.

Results: Among 177 EDU admissions there were 33 EMRs and 17 medical transfers. On average, inpatients with EMRs or medical transfers were older with greater medical multimorbidity/polypharmacy, and a higher proportion of atypical anorexia nervosa and anorexia nervosa – binge/purge subtype. EMR indications included postural tachycardia, hypotension, sinus tachycardia, hypokalaemia, hypoglycaemia, altered conscious state, and chest pain. Medical admission indications included refeeding for vital sign derangement, intravenous potassium, vital sign derangement or falls attributed to antipsychotics, infection, abdominal pain, and self-harm.

Conclusion: Early medical assessment and intensive monitoring are needed for older patients with greater medical multimorbidity/polypharmacy, orthostasis, or higher risk of electrolyte instability. Caution should be undertaken regarding antipsychotic use in this vulnerable population.