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September 4, 2019

Initial Assessment for Life-Threatening Eating Disorders

BY Angel MedFlight
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A Hospital Case Manager’s Perspective on the Initial Assessment for Life-threatening Eating Disorders and Access to Air Ambulance

Eating disorders have the second-highest mortality rate of all mental health disorders, surpassed only by opioid addiction.*

*According to the National Eating Disorder Association's website

As a hospital-based social worker or case manager, we're often guided by an initial assessment completed by an emergency department clinician or by a nurse or physician caring for an admitted patient. This initial assessment inventories what the patient is currently experiencing given their presenting problems with an ordered battery of testing to follow, hopeful to determine the root cause of their concerns. At this point, case management or social work departments are often assigned to the patient's case to conduct a more thorough biopsychosocial assessment and determination of what a client may be experiencing. This presents a critical opportunity to explore a patient's potential to be suffering from an eating disorder, which may be hidden due to the patient's feelings of shame and control associated with an eating disorder.

The following conditions could indicate Medical Complications associated with Severe Malnutrition due to an Eating Disorder:

  • Recurring patients with nonspecific complaints (especially in adolescents) such as: feeling cold, fatigued, bloated, constipation, swelling of hands or feet, numbness and tingling, amenorrhea (missed and/or absence of menstrual periods)
  • Severe or Rapid Weight-loss
  • Nonspecific Cardiopulmonary Symptoms such as fatigue, heart palpitations or fainting
  • Low Blood Pressure, Low Heart Rate, Critically Low Potassium with Edema
  • Limited family involvement (a refusal to sign Release of Information, secrecy, and resistance to interventions)

To help determine if an eating disorder is present when assessing your patient for their presenting concerns, here are five important questions to ask the patient:

  1. When was the last time you ate, and what have you eaten in the last 24 hours?
  2. Do you take over the counter supplements or medications to control your body shape or size?
  3. Do you worry about gaining weight, or the size of your body?
  4. Do you ever eat until you are uncomfortably full?
  5. Is your family concerned about your eating habits?

If your client is affirming any of these questions, consider a more thorough biopsychosocial assessment to determine if the client meets the criteria for an eating disorder as outlined in the DSM-5.

What are the guidelines for determining levels of care for an eating disorder?

Graphic showing levels of care based on Ideal Body Weight
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Why is air ambulance transport helpful to eating disorder patients?

Only a handful of facilities in the country have medical expertise, psychological support, and nutritional services to successfully treat patients with the most severe cases of eating disorders. Commercial air travel or long-distance ground transportation is too dangerous for these medically fragile patients. This limits treatment choices to local programs which may not have the comprehensive services necessary for recovery.

An air ambulance expands patients’ care options by providing safe access to specialty hospitals hundreds or thousands of miles away. With a medical flight, patients can receive the life-saving treatment they need in the care of renowned eating disorder experts.

What type of care is provided on a transport for a patient with an eating disorder?

In addition to the usual level of care provided, specific guidelines are instituted to manage the severe eating disorder patient’s unique needs during transport. The guidelines ensure patients arrive safely ready for treatment

  • Patient’s glucose levels are monitored closely to prevent hypoglycemia and ensure patient health during transport.
  • To combat the dehydration and hypoglycemia, these patients often experience, intravenous fluids, such as normal saline with glucose, are started and continued through the flight. This prevents dangerous complications during the transport and ensures patient safety.
  • Typically tube feedings are discontinued for flight. For patients with severe eating disorders, physician-prescribed continuous or bolus tube feedings are continued throughout transfer.
  • Eating disorder patients often experience hypothermia because of low body mass and decreased metabolism. During flight special emphasis on temperature control and warmth is necessary to decrease the potential for complications that can arise. Special blankets and warming techniques are available to combat heat loss.
  • Special consideration is given to ensuring comfort and padding of bony prominences to accommodate the patient’s diminutive size and low percentage of body fat. This prevents possible pressure-related injuries.

How to find resources for eating disorder clients that may be needing a referral to any level of care

Now that we understand eating disorders and the different types of facilities that may be involved in patient care, we can look at what’s next. Below is a list of resources available to help you determine what the next steps for your patients’ journey may be.

ACUTE Center for Eating Disorders at Denver Health:
Phone: (877) 228-8348

The Alliance for Eating Disorders Awareness:
Phone: (866) 662-1235

National Eating Disorder Association:
Phone: (800) 931-2237

International Association of Eating Disorder Professionals:
Phone: (800) 800-8126

Residential Eating Disorder Consortium:
Phone: (646) 553-1340

Academy of Eating Disorders:
Phone: (703) 234-4079

Tammie Williams' portrait

Written by:
Tammie Williams, LCSW
Lead Clinical Social Worker

Tammie Williams, LCSW is a Clinical Social worker specializing in the identification and treatment of patients with severe malnutrition due to eating disorders or other serious medical complications related to an eating disorder.

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