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Admission Criteria

Eating Disorders Admission Criteria

The following evidence-based criteria are used in medical decision- making when considering admission to CM

*Orthostatic findings, eating disorder behaviors, or high risk for refeeding syndrome alone may not be sufficient to support admission. Consider these findings alongside other admission criteria and the patient's overall clinical presentation 
Heart Rate/EKG
  • < 50 bpm while awake, < 45 bpm while sleeping, or any noted arrhythmias
Blood Pressure
  • BP < 90/45 with associated symptoms
*Orthostatics
  • HR increase > 20 bpm or a systolic BP decrease > 10 bpm, with associated symptoms
Temperature
  • Hypothermia (body temperature < 96o F or 35.6o C)
Electrolytes
  • Requires replacement therapy or monitoring that is not feasible or safe to complete in the outpatient setting 
(i.e., glucose < 60 mg/dL and potassium < 3.0 mmol/L should prompt a call to 1800GoMercy)
Other
  • Frank hematemesis (suggesting a Mallory-Wiese tear or GI bleed)
  • Hypovolemic shock
Behaviors

Those that have caused a medical complication requiring acute and/or frequent monitoring, such as:

  • Prolonged food refusal (as defined by the outpatient treating provider)
  • Uncontrollable vomiting (with high risk of EKG changes, electrolyte abnormalities, or severe dehydration)
  • Other eating disorder behaviors (i.e., hiding food, over-exercising, researching eating disorder facts)
*High risk of refeeding syndrome

Risk factors for severe refeeding syndrome include:

  • < 75% total body weight
  • Rapid and prolonged weight loss
  • Prolonged, severe PO (by mouth) restriction (defined as 500 kcal/day or less for > 7 days)
  • Significant carbohydrate restriction (< 30% of total daily intake)
For medically stable patients, current evidence supports refeeding in the outpatient setting.
Suicidal

After the acute mental health screener (AMHS)/mental health provider has completed their evaluation:

  • Medically unstable - consider hospitalization
  • Medically stable - outpatient or acute psych based on AMHS recommendations

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.