Lens extraction in diabetic patients.

Abstract

<h3>Aims</h3> Anorexia Nervosa (AN) is a mental health disorder in which one restricts their calorific intake to reduce their weight, leading to serious health implications. It has become increasingly prevalent particularly during the COVID-19 pandemic. The eating disorders (ED) service has seen an increase in the number of young people being referred (figure 1). This has resulted in protracted waiting times from receipt of referral to formal assessment by the team and an associated strain on resources available to manage this group. I set out to explore what this has meant for patient care and whether there are ways these patients could be managed more efficiently whilst ensuring the best outcome. <h3>Methods</h3> Measures existed within the ED service to support patients prior to assessment to reduce mental and physical deterioration. The effects and success of these haven’t been evaluated, nor are the interventions particularly centred around young people developing ED during the pandemic. In the first instance I retrospectively reviewed the notes of 60 patients aged 10-18 diagnosed with AN between December 2019 and December 2021. I examined whether Key Performance Indicators (KPI) were breached by looking at waiting time from referral to assessment. In addition, weight for height (W4H) at referral was compared to W4H at assessment, admissions to hospital during this period were considered, physical or mental health deterioration prior to assessment and reasons for developing AN were also reviewed. I suggested and implemented improvement measures to mitigate deterioration whilst awaiting an assessment. These measures included: • A triage pack containing a meal plan and signposting in case of deterioration (e.g., AN charity, crisis team contact) • Introduction of a GP letter featuring advice for monitoring and safety net advice • Paediatric clinic appointment for those thought to need physical review prior to assessment. This clinic is run by a liaison Paediatrician working as part of the ED team. I then carried out the same analysis on patients after the measures were put in place. Comparisons have been made to ascertain whether patients referred between January and March 2022 show less physical and mental deterioration compared to those referred prior to implementing the measures. Additionally, I interviewed staff and patients to obtain their views on the changes introduced. <h3>Results</h3> The characteristics of the young people from both the pre and post intervention group were comparable. Of note, prior to intervention, KPI was met in 36.7% of young people with the remaining 63.3% breaching KPI. The interventions have so far resulted in an overall improvement with more young people meeting KPI and less deterioration seen prior to assessment with interventions being viewed as positive in general by both staff and young people. <h3>Conclusion</h3> It is important that young people receive the best standard of care catered to their specific needs. These results are promising and provide a further framework for managing this group of patients as although the adverse effects of the covid-19 pandemic have lessened, the long-term effects on mental health are not fully appreciated.