A new framework has been developed to support critical care clinicians in the care of people with severe eating disorders in life-threatening situations.

A new framework to support critical care clinicians in the care of people with severe eating disorders in life-threatening situations who are referred to critical care via mental health services has been developed by the College of Intensive Care Medicine and the Intensive Care Society.

It provides a framework to care for people who are under the care of eating disorders/liaison psychiatry teams and who have been referred to critical care, following a multidisciplinary team decision, so that they can receive nutrition to sustain life.

It was developed in response to a growing number of requests from clinicians for advice on how to provide the best care for this patient cohort. Although professional guidance exists for providing assisted nutrition to patients experiencing eating disorders, it does not include comprehensive information for situations involving critical care.

“These situations are very rare but can be extremely challenging. As a College, our members have asked us for resources to assist them with the complex ethical, medico-legal, and clinical aspects of managing these cases,” said Monika Beatty, chair of the Legal & Ethical Policy Unit.

Least restrictive option

The framework focuses on the challenges that can arise when an adult with life-threatening complications of an eating disorder is referred to critical care for assisted feeding, having been under the care of an eating disorders or liaison psychiatry team. It does not cover patients who need critical care for other indications such as trauma or sepsis.

It does not advocate for any particular course of treatment. It encourages the least restrictive option in every case and is clear that these interventions should never become a routine part of care.

“It is essential that we care for our patients in the best way possible and a framework which provides key information and signposts relevant resources, will assist those involved, to make nuanced decisions and recommendations for the person’s overall benefit,” Beatty added.

The framework was developed by members of the College of Intensive Care Medicine’s Legal and Ethical Policy Unit (LEPU), working with critical care consultants, psychiatrists, legal professionals, and patient and lay representatives. It is endorsed by the Intensive Care Society and the Northern Irish, Scottish and Welsh Intensive Care Societies.

The Faculty of Liaison Psychiatry of the Royal College of Psychiatrists, authors of the Medical Emergencies in Eating Disorders (MEED) and Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) guidance, and representatives from the Intensive Care Society’s Legal and Ethical Advisory Group (LEAG) were also consulted.