Quality statement 6: Risk assessment when moving between services

Quality statement

People with eating disorders who are moving between services have their risks assessed.

Rationale

People with eating disorders might need to move from services for children and young people to adult services, between inpatient and outpatient services, between different geographical areas (common for students) or back to primary care after specialist treatment.

Particular care should be taken when people move between services because poor communication between services can lead to inconsistent messages and management approaches. Transition protocols, including risk assessment and monitoring, will ensure that treatment and support is not compromised and healthcare professionals all know about the person's care needs and plans for ongoing management.

Quality measures

Structure

a) Evidence of joint transition protocols between eating disorder services and other services, using formal processes of care planning such as the Care Programme Approach (CPA).

Data source: Local data collection, for example, contracts and service specifications. NHS England's NHS standard contract for specialised eating disorders (adults) (2013) includes details of transition and care planning using the CPA.

b) Evidence of joint working arrangements, including regular liaison and meetings, to discuss risk assessment and monitoring at transition between eating disorder services and other services providing care for people with eating disorders.

Data source: Local data collection, for example, contracts and service specifications. The Royal College of Psychiatrists' Managing transitions when the patient has an eating disorder (2017) includes details on transition management. Also The Royal College of Psychiatrists' Junior MARSIPAN: Management of really sick patients under 18 with anorexia nervosa (2012) and MARSIPAN: Management of really sick patients with anorexia nervosa (2014) include details of risk assessment and transfer between services.

Process

a) Proportion of people with eating disorders moving between services who have a care plan that includes a risk assessment before transfer.

Numerator – the number in the denominator who have a care plan that includes a risk assessment before transfer.

Denominator – the number of people with eating disorders who are moving between services.

Data source: Local data collection, for example, local audits of care plans.

b) Proportion of people with eating disorders moving between services who have a care plan that includes a risk assessment after transfer.

Numerator – the number in the denominator who have a care plan that includes a risk assessment after transfer.

Denominator – the number of people with eating disorders who are moving between services.

Data source: Local data collection, for example, local audits of care plans.

Outcomes

a) Proportion of people with eating disorders who have moved between services and did not attend their first meeting or appointment.

Data source:  Local data collection, for example, local audit of electronic records.

b) Relapse rate of people with eating disorders who move between services.

Data source: Local data collection, for example, local audit of electronic records.

c) Service user experience of eating disorder services.

Data source: Local data collection, for example, using patient surveys.

What the quality statement means for different audiences

Service providers (such as specialist inpatient and outpatient eating disorder services, community-based eating disorder teams, services for children and young people, and adult services) ensure that processes are in place between eating disorder services and other services at transfer for risk assessment and monitoring, with ongoing management recorded in the agreed care plan.

Healthcare professionals (such as GPs, case managers or care coordinators within specialist eating disorder services) perform risk assessments when people with eating disorders move from one service to another. At the time of transfer, they communicate the care plan at a recorded meeting with all the services involved and the person and their family or carers, if appropriate. It is clear what will happen during and after transfer of care, with clear roles and responsibilities to all relevant healthcare professionals involved as well as to the person. Risk assessment and monitoring will be highlighted as a key area of concern at transfer.

Commissioners (such as clinical commissioning groups, NHS England and local authorities) ensure that the services they commission work together at transfer of care to deliver risk assessment and monitoring for people with eating disorders.

People with eating disorders who are moving between services (including from services for children and young people to adult services, inpatient to outpatient services, stepping up or down between intensity of treatments, and moving from one area to another, for example, from home to university) have a risk assessment at the time of transfer. The risk assessment is explained at a meeting, recorded in their agreed care plan and monitored over time. Also clear roles and responsibilities are defined to all relevant healthcare professionals as well as to the person.

Source guidance

Eating disorders: recognition and treatment (2017) NICE guideline NG69, recommendation 1.1.18