The Eating Disorders Team clinical outcomes and feedback

The Feeding and Eating Disorders Service was noted in the Care Quality Commission Inspection Report for Great Ormond Street Hospital as having a number of areas of outstanding practice. These include that because the hospital is treating many patients that could be treated at very few hospitals in the UK it is developing ground breaking clinical guidance which it is sharing with clinical colleagues in the wider medical community and the fact that we are actively involved in research.

We are also committed to measuring clinical outcomes for the care that we deliver. Clinical outcomes are broadly agreed, measurable changes in health or quality of life that result from our care. Constant review of our clinical outcomes establishes standards against which to continuously improve all aspects of our practice. We have lots of outcome data on different measures, so if you don’t see the answer to a question you have, please ask!

A number of the young people come to EDT for an assessment only and therefore outcomes are expressed in terms of satisfaction with the service. Between May 2014 to December 2016, the average score parents and carers gave regarding the EDT service was 4.25 out of 5. Children and young people scored the service as being 4.3 out of 5. The graph below shows the average scoring for each of these aspects.p>

In the same cohort of patients, families rated their experience of assessment with the EDT very highly, with 78 per cent of parents and carers giving us purely positive feedback. Of respondents who gave areas for improvement, most related to the organisation as a whole (especially travel) rather than our service specifically.

Here are some comments from parents about the assessment:

The Children’s Global Assessment Scale (CGAS) is a scale used by clinicians to rate the level of functioning in children and adolescents.  It includes the extent to which mental health difficulties impact school function and interpersonal relationships, as well as the level of care needed. Patients are given a score between 1 and 100 based on a glossary of criteria. The graph below shows the average CGAS for young people who have seen the EDT for outpatient treatment since 2013. When a person finishes treatment at GOSH they may continue to receive care through their local teams. A score of 43 (baseline average) means ‘Major impairment of functioning in several areas and unable to function in one of these areas’. A score of 67 (end of treatment at GOSH) is at the higher end of the category ‘Some difficulty in a single area but generally functioning pretty well’.

Weight for height (% BMI) is also an important outcome for those patients who are malnourished at the point of presentation. As weight and height change as a young person grows up, their BMI must be interpreted relative to other people of the same age and sex. A higher percentage is indicative of the young person being more similar to their peers. The graph below shows the average %BMI of young people at the start and end of their treatment (since 2012). 60 per cent of these patients have a diagnosis of anorexia nervosa or atypical anorexia nervosa; the remainder have other avoidant restrictive food intake (ARFID) presentations.

The graph below indicates how the average number of days that patients with eating difficulties are inpatients on Mildred Creak Unit has been reducing over the last few years. This has been made possible by:

The introduction of a refeeding protocol, which enabled rate of weight gain to increase 2.7 times between 2014 and 2016, with no adverse effects.

• Stepping down to day care for those who live near enough
• Good admission planning (where possible) and clear admission goals
• Close working with local teams