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BACKGROUND: The aim of this study was to understand current clinical practice, adherence to evidence-based guidelines, and the perceptions, knowledge and attitudes of the multidisciplinary team caring for inpatients with an eating disorder at a small metro hospital. METHODS: This mixed methods study involved a retrospective audit of eating disorder patient care and a semi-qualitative staff survey. The audit was undertaken at a small metro hospital from 2018 to 2019. Documented practices were compared to state-wide best-practice guidelines. A staff survey was designed to understand health care professional's knowledge and use of evidence-based practice guidelines, as well their perception of caring for this patient population and areas for improvement. RESULTS: Twenty-three discrete admissions (18 individuals) were included in the audit. Findings highlighted several evidence-practice gaps including delayed nutrition initiation and inconsistent medical refeeding and management of refeeding risk. Survey themes (from 60 hospital staff) included: lack of confidence with providing eating disorder care; uncertainty about professional roles/responsibilities; and lack of clear processes/guidelines to inform clinical care. CONCLUSIONS: Gaps exist between evidence-based practice and eating disorder patient care. Staff lack confidence providing care to this patient group. These findings will allow for targeted implementation strategies to improve patient care and the uptake of research into practice.
Best practice guidelines for inpatient eating disorder (ED) care have not been consistently well implemented at our regional hospital. This research project aimed to address this problem in two phases. Phase one involved understanding: (1) current clinical practice and adherence to evidence based guidelines through a retrospective clinical audit and (2) the perceptions, barriers, enablers and attitudes of the multidisciplinary team providing ED care using a staff survey. The results of these activities highlighted areas for improvement and will be used to guide implementation strategies to align patient care with evidence based practice.
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OBJECTIVE: To evaluate the effects of updated gestational diabetes mellitus (GDM) screening and diagnostic criteria on selected perinatal outcomes in Queensland, Australia. METHODS: This was a pre-post comparison study using perinatal data the year before (2014) and after (2016) the screening and diagnostic criteria for GDM was changed in Queensland, Australia. In 2015, Queensland adopted the one-step screening and diagnostic criteria based on the International Association of the Diabetes and Pregnancy Study Groups' recommendations. The data from 62,517 women in 2014 and 61,600 women in 2016 who gave birth from 24 weeks of gestation were analyzed in three groups in each year: women with GDM; women without diagnosed GDM; and total population. The outcome measures were gestational hypertension, cesarean birth, gestational age at delivery, birth weight, preterm delivery, large-for-gestational age (LGA) neonates, small-for-gestational-age (SGA) neonates, neonatal hypoglycemia, and respiratory distress. RESULTS: The diagnosis of GDM increased from 8.7% (n=5,462) to 11.9% (n=7,317). After changing the diagnostic criteria, the changes to outcomes, odds ratios (OR), and adjusted odds ratios (aOR) (95% CI) for outcomes with statistically significant differences for the total population were: gestational hypertension 4.6% vs 5.0%, OR 1.09 (1.03-1.15), aOR 1.07 (1.02-1.13); preterm birth 7.6% vs 8.0%, OR 1.05 (1.01-1.09), aOR 1.06 (1.02-1.10); neonatal hypoglycemia 5.3% vs 6.8%, OR 1.31 (1.25-1.37), aOR 1.32 (1.25-1.38); and respiratory distress 6.2% vs 6.0%, OR 0.96 (0.91-1.00), aOR 0.94 (0.89-0.99). There was no change to cesarean births or LGA or SGA neonates for women with or without diagnosed GDM or the total population. CONCLUSION: Except for a very small decrease in respiratory distress, changing the diagnostic criteria has resulted in more GDM diagnoses with no observed changes to measured perinatal outcomes for women with and without diagnosed GDM.
