Guidance for Use of Pre-Admission and Discharge Checklists (where the next admission will be at least the third admission in three years)

  1. The clinical Commissioner / case manager will identify a referral with a potential third (or more) admission in three years.
  2. Clinical commissioner will contact SEDU and referrer, ask if there is a rationale for considering admission to a different SEDU, and if not, arrange pre-admission meeting to review the ‘Before Admission’ section of the preadmission checklist.
  3. At subsequent CPAs consider ‘During admission’ and ‘Family involvement’ sections of the checklist.
  4. As discharge planning begins, move to reviewing the ‘Discharge Checklist for people with multiple admissions’.

 

To be used in a pre-admission planning meeting and CPAs for people for who this would be at least their 3rd admissions in 3 years

Before Admission

 

 

Consider whether benefits of a different SEDU outweigh benefits of continuity

 

 

 

Review lessons and effective approaches from previous admissions

 

 

 

Consider different target BMI or length of admission

 

 

 

Arrange preadmission aims planning meeting with SEDU, CEDS, Individual and family, including target length of stay and wider goals

 

 

Ensure handover of psychological work and formulation from community to SEDU

 

 

 

Consider reflective practice slots with inpatient staff to name and address feelings about re admission- holding hope

 

 

Provide preadmission pack to service user.

 

 

 

Provide family support pack

 

 

 

During Admission

 

 

Ensure treatment of co-morbidities is optimised (medication, psychological and rehabilitation work with Occupational Therapy)

 

 

  

Ensure adjustments to accommodate ASC are made

 

 

  

Discuss with person recovery stories and reasons this admission could be different

 

 

  

Consider financial position and if necessary, arrange benefits review

 

 

  
 

Ensure OT work on developing skills and interests to develop roles outside eating disorder

 

 

 

Consider psychological work on identity outside eating disorder

 

 

  
 

Family Involvement

 

 

Actively promote the involvement of family and friends, working through barriers and resistance to this, unless there are specific disadvantages to this

 

 

 

Consider providing specific advice /training to family, particularly about practicalities of mealtimes

 

 

Ensure family perspective is gained and incorporated in care plan

 

 

 

Signpost family to external support.

 

 

 

Ensure Empowered communication template is followed

 

 

 

If available has family therapy been offered?

 

 

 

Ensure all barriers to recovery are addressed even if not present on SEDU (e.g. planning for eating at work /education)

 

 

 

 

Click here to download the full checklist - Readmission Checklist 

To be used in the discharge CPA for individuals with at least 3 admissions in 3 years

This document aims to ensure holistic discharge planning has occurred collaboratively between SEDU, CEDS and the person being discharged to promote recovery and avoid the need for further admissions.

 

  

Have the CEDS, SEDU and service user reflected on previous discharges, and periods of leave to inform final discharge plan /package?

 

Have necessary referrals been made to ensure support is ready on discharge, including for co-morbid conditions?

 

 

Have intensive community support options been considered?

 

 

Has the community team informed SEDU and service user of any change in community care team compared to prior to admission?

 

Have there been periods of home leave with review by community team to ease transition?

 

 

Has the Empowered communications template been followed?

 

 

 

Ensure handover of psychological work and formulation from SEDU to community team

 

 

Does the service users have the necessary resources to allow them to engage with the plan (e.g. means of travelling to appointments)

 

Is there evidence the current psychological approach is effective or that an alternative approach may be beneficial?

 

Has wider support on discharge e.g. charities, housing, social, education been considered?

 

 

Has the way that family will be involved in the community plan been agreed by all?

 

 

Have family been offered carer support?

 

 

Would it be useful to identify threshold for readmission?

 

 

 

Has a discharge pack been offered?

 

 

 

 

Click here to download the full checklist - Pre Discharge Relapse Prevention Checklist 

  • We are aware that the checklists and associated pre-admission meeting will require an additional time commitment, however, the high threshold of three admissions in three years mean this is will only be used for a small group of people who are most likely to benefit from this additional planning.
  • If desired, it is entirely acceptable to also use the checklists for other people, for example if previous admissions have been particularly long, difficult or of limited value. This is at the discretion of the clinicians involved.

If there are any suggestions about amendments to either checklist, please contact Duncan Campbell - Head of Clinical Commissioning for Empowered.

Empowered will initially use the Checklists for one year, and will review their ease of use and efficacy in September 2026.