Effective use of existing resources to support development of integrated care pathways - bringing hospital and community together

Background: Prevalence of eating disorders has reportedly increased over the last several years. High comorbidity levels both with physical and other mental illnesses and mortality, particularly in anorexia nervosa, are associated. Further to prior planning a service was set up in the community in Cork and Kerry for the treatment of eating disorders. However, no specific eating disorder beds exist to date in the region. This presentation aims to provide a description of quality improvement steps taken to bridging the gap between hospital and community and increasing collaboration during the transition period.

 

Approach: The team has been implementing the model of care for eating disorders in Ireland locally and for the last couple of years. Multiple stakeholders were involved including feedback received from service users, multiple meetings with colleagues locally and nationally, including liaison and general adult psychiatry and consultant physicians, regular meetings with local management structures including a Steering Group, the National Clinical Programme for Eating Disorders (NCPED), among others.

 

Part of the team joined a one year post graduate programme with the RCPI on Quality Improvement Leadership in Healthcare which promoted further knowledge and skills in quality improvement and incorporation of same throughout the development of the Service. The current presentation focuses on the description of the care pathways established in the absence of eating disorder beds for people with eating disorders in the region and the processes that were used to achieve it.

 

Results: Serving a population of about 750,000 people the team has received a substantial amount of referrals within a couple of years of existence. Collaboration includes contact with person referred and referrer - General Practitioner or Consultant. Information on the referral, including the MEED (Medical Emergencies in Eating Disorders https://www.hse.ie/eng/about/who/cspd/ncps/emp/resources/eating-disorders-in-the-emergency-department.pdf), and from the latter guiding next steps. Consultations are often offered regarding specific presentations.

Broadly, multiple presentations and meetings have occurred since the team has come together. Specifically to address the lack of eating disorders beds in the region, meetings so far included: in-person with liaison psychiatry, a presentation to colleagues in the acute medical assessment unit in the biggest hospital in the region, others with liaison, general adult psychiatry and management structures.

 

These yielded not only facilitated communication with colleagues but also changes to design, namely: a ‘meet and greet’ with outreach from the team to hospital in advance of discharge of person referred was introduced, a guidance document regarding communication with people with eating disorders was elaborated by the team and shared with hospital colleagues, participation by the team at multidisciplinary team (MDT) meetings in the hospital has occurred prior to discharges. Further meetings are being held to further facilitate transitions and improve care. Feedback received so far from multiple stakeholders reinforces the relevance of such approaches to bridge the gap between hospital and community in the region.

 

Implications: This study highlights the importance of an effective use of existing resources to support development of integrated care pathways, particularly in bringing hospital and community together, while ensuring patient safety and quality improvement.