Creating a hospital-based nutrition pathway for adults: evaluation of implementation in two United States hospital-systems

Since the COVID-19 pandemic there has been a rise in the incidence and severity of eating disorders (ED). The Hospital of the University of Pennsylvania (HUP) and University of Michigan Hospital System (UMHS) have similarly seen a rise in the incidence and severity of patients admitted with eating disorders. Until 2023, no formal pathway existed for the treatment of malnutrition in adult patients with ED at either hospital system. The Consolidated Framework for Implementation Research (CFIR) was used by program leads at both HUP and UMHS for the identification of barriers and facilitators influencing the implementation of a treatment pathway for adult patients with eating disorders admitted to the medical floors. The pathways at UMHS and HUP were overall remarkably similar and many of the same barriers and facilitators impacting the implementation of the treatment pathways were identified within both programs. Both programs consist of care bundles involving structured, observed meals with daily calorie goals for patients, frequent electrolyte monitoring, and daily blind weights. These treatment pathways address the treatment of malnutrition in adults with eating disorders admitted to inpatient medical floors in general hospital settings with no prior history of eating disorder expertise, and both have been successfully implemented at HUP and UMHS thereby providing much-needed services for this patient population. The manuscript expands on existing literature by describing the facilitators and limitations of the implementation of an eating disorder protocol in a general adult hospital setting. Both the Hospital of the University of Pennsylvania and the University of Michigan Hospital System have seen a rise in the incidence and severity of adult patients with a diagnosis of an eating disorder admitted to medical floors with malnutrition. In response, both hospitals implemented pathways to treat malnutrition for these adult patients on the medical floors. This manuscript explores the remarkably similar facilitators and barriers to the implementation of these pathways at both hospital systems. These treatment pathways address the treatment of malnutrition in adults with eating disorders admitted to inpatient medical floors in general hospital settings with no prior history of eating disorder expertise.