Title : Reducing acuity and recidivism in pediatric eating disorders: Implementing early intervention and interdisciplinary care
Abstract:
In pediatric populations, eating disorders are life-threatening conditions, with anorexia nervosa carrying the highest mortality rate among psychiatric disorders and placing patients at risk for significant long-term medical complications. Prior to the COVID-19 pandemic, our pediatric eating disorder program within a pediatric academic medical center demonstrated strong clinical outcomes, maintaining recidivism rates below 5%, and outperforming national benchmarks. Beginning in 2020, a marked increase in patient volume and acuity was observed, with children presenting at lower body weights, greater medical instability, and requiring more frequent inpatient admissions. Recidivism rates rose significantly and remained elevated post-pandemic, while increased demand for behavioral health resources in acute care settings exposed critical gaps in traditional care models. In response, a structured interdisciplinary early intervention program was implemented to address rising complexity and improve patient outcomes. Key strategies included earlier identification of high-risk patients, enhanced refeeding protocols, revised treatment approaches, and expanded integration of psychiatric services across the care continuum. Care models were adapted to address increasing medical complexity, including the concurrent management of co-occurring medical conditions alongside eating disorder treatment. Nursing leadership played a central role in implementation, care coordination, and standardization of practice across disciplines. Following implementation, measurable improvements were achieved. Among inpatient admissions, average length of stay decreased by 12.3%, from 21.9 days in 2023 (n=103) to 19.2 days in 2025 (n=235), with sustained volume in 2024 (21.7 days; n=331), reflecting improved efficiency and care coordination. Recidivism rates demonstrated a sustained downward trend, declining from 20.6% in 2024 (n=116) to 17.9% in 2025 (n=107) and 9.4% through Q2 2026 (n=32), representing a relative reduction of over 50% and meaningful progress toward pre-pandemic benchmarks. This program demonstrates that early intervention and interdisciplinary collaboration can effectively improve outcomes in pediatric eating disorder populations experiencing increased acuity and complexity. Findings highlight the critical role of nursing leadership in implementing adaptive, integrated care models to address complex, high-risk conditions in the evolving post-pandemic healthcare environment.
