Connecting care and improving outcomes for patients with eating disorders
Managing medical emergencies for people with eating disorders requires a fast and integrated response. Delays in recognising physical deterioration can have devastating consequences. To address this, Lincolnshire Partnership NHS Foundation Trust, member organisation of the East Midlands Alliance, has completed a two-year pilot, funded by the East Midlands Adult Eating Disorders Collaborative.
MEED (The Medical Emergencies in Eating Disorders) guidelines in 2022 highlighted a stark reality: eating disorders have some of the highest mortality rates of any mental health condition, and patients continue to experience serious harm when physical deterioration is not recognised and managed promptly. MEED called for stronger integration between physical and mental health services.
In Lincolnshire, this challenge was amplified by increasing referrals and limited specialist inpatient provision. More medically unstable patients were being managed within acute hospitals. In response to this, a two-year MEED Practitioner pilot was commissioned. The role aimed to bridge gaps between services and within the first four months, taking a collaborative approach from the outset, referrals and clinical activity increased significantly.
Aims of the pilot
A set of clear aims were set out to:
- Improve patient safety
- Embed MEED guidance into practice
- Bridge physical and mental health services
- Support acute hospitals managing medical emergencies in eating disorders
- Improve staff confidence and capability
- Reduce avoidable admissions and delays
The vision was for physical and mental health services to work together rather than in parallel, shifting from fragmented, reactive care to coordinated, risk-led care.
How the role evolved
The role developed into a system-wide connector, supporting admissions and discharge planning while also contributing to pathway development, workforce training, multidisciplinary team (MDT) coordination, guideline development and primary care liaison. Crucially, the role helped embed a shift from diagnosis-based to risk-based thinking.
A patient's story: coordinated care in practice
A medically unstable patient attended their eating disorder service appointment with significant physical deterioration. The MEED Liaison Practitioner was able to:
- Coordinate the escalation and facilitate an urgent admission to the acute hospital
- Facilitate communication across multiple teams to move them through their pathway of care and avoid long waits
- Support the patient and family from admission
- Lead MDT planning and ongoing care
- Help avoid restrictive interventions through therapeutic engagement during admission
Cheryl Butler, MEED Liaison Practitioner said:
Having a MEED Liaison Practitioner in place resulted in earlier recognition, coordinated treatment, safer care. The role provided a single point of coordination and continuity throughout the patient's journey.
Impact of the pilot
Over two years the role has:
- Supported 44 high-risk medical admission
- Facilitated 142 MDT meetings
- Managed 745 GP escalations relating to physical health concerns during a period of reduced psychiatry cover
- Developed trust-wide guidance, pathways, clinical tools, physical health monitoring standards, competency framework and workforce development initiatives
- Reduced reliance on specialist admission
- Increased staff confidence and MEED compliance
Cheryl said:
When we look beyond the activity data, the most significant achievement of the pilot has been the change in how the system responds to eating disorder-related medical emergencies.
Prior to the pilot, care could be variable, pathways were less established, and escalation often depended on individual clinicians knowing who to contact or how to navigate the system. Now, acute teams have clearer pathways and earlier identification of risk.
Communication between acute hospitals, Adult Eating Disorder Services, primary care and specialist teams has become more consistent. Rather than focusing solely on diagnosis, medical risk drives decision-making. This means patients with severe disordered eating, who may not meet criteria for an eating disorder diagnosis, are still able to access the appropriate level of MEED aligned intervention.
Looking ahead
Building on the pilot's success, opportunities include strengthening pathways at Pilgrim Hospital in Boston, developing closer collaboration with diabetes services, continuing workforce development, and further embedding MEED principles across the Trust.
Sarah Connery, CEO of Lincolnshire Partnership NHS Foundation Trust, said:
We are extremely proud to have funded this pilot and to see the positive impact it has had over the last two years. The work has shown how a dedicated role can help bring together different teams, reduce delays and ensure patients receive the right care at the right time.
The achievements in Lincolnshire provide a strong foundation for future service development, and we look forward to exploring how this approach can be expanded and adapted to benefit more patients across the East Midlands.