SBAR Urgent Paediatric Referral Template

SBAR Urgent Paediatric Referral Template Referral Details Young Person Name: Amelia Smith DOB: 15/03/2010 NHS Number: 123 456 7890 Referred by: Dr. Sarah Jenkins Referrer's Department within CAMHS: Eating Disorders Team Referrer's contact number: "0300 123 6632 (Portsmouth) 0300 123 6617 (Southampton)" Date and Time of referral: 01/11/2024 14:30 Current risk assessment: Amelia presents with significant weight loss, bradycardia, and postural hypotension, indicating a high medical risk due to restrictive eating behaviours. She also reports passive suicidal ideation. ACTION FOR PAEDIATRICS: * Urgent medical assessment for refeeding syndrome risk and cardiac stability. * Daily vital sign monitoring and electrolyte checks. * Consider nasogastric feeding if oral intake remains insufficient. ACTION FOR GP: * Monitor physical health and liaise with paediatrics and CAMHS. * Arrange blood tests for full blood count, U&Es, LFTs, magnesium, phosphate. ACTION FOR CAMHS: * Expedite specialist eating disorder assessment and treatment plan. * Provide daily psychological support and meal support interventions. ACTION FOR PARENTS / CARERS: * Closely supervise all meals and snacks. * Encourage fluid intake. * Monitor for any compensatory behaviours. ACTION FOR PATIENT: * Engage with meal support. * Communicate any physical symptoms or distress. SBAR: This 14-year-old female presents with severe restrictive eating behaviours and rapid weight loss, indicating significant MEED red flags for cardiovascular instability and electrolyte imbalance. Situation Amelia, a 14-year-old female, is presenting with a significant deterioration in her physical health due to highly restrictive eating behaviours over the past three months. Her parents report that she has become increasingly withdrawn, anxious around food, and has lost a noticeable amount of weight. She denies feeling hungry and expresses significant body dissatisfaction. Concerns are heightened by recent reports of dizziness and fatigue. Physical observations and weight loss: Amelia has lost 10 kg in the last three months. Her current weight is 35 kg. She exhibits bradycardia (HR 45 bpm sitting) and postural hypotension (BP drop of 25/15 mmHg on standing). Her temperature is consistently low at 35.8°C. Co-occurring physical symptoms or behaviours and their duration including chest pain, food/fluid refusal: Amelia reports occasional chest pain, particularly with exertion, for the past two weeks. She has been actively refusing most solid foods and fluids for the last week, often drinking only water. She reports feeling lightheaded when standing quickly. Background Working diagnosis: Anorexia Nervosa, severe type. Treatment plan and duration in treatment: Amelia has been seen by CAMHS for general anxiety for 6 months, but specialist eating disorder treatment has not yet commenced due to waiting lists. Any comorbid mental or physical health diagnosis: * Generalised Anxiety Disorder Rapidity of weight loss including whether acute or chronic, with MEED risk rating: Acute weight loss of 10 kg in 3 months, classified as Red MEED risk due to rapid and severe nature. Premorbid weight with timeframe for weight changes: Amelia's stable premorbid weight was 45 kg up until 4 months ago. Current food and fluid intake or stage of meal plan, including estimate of current daily calorie intake: Amelia is currently consuming less than 400 kcal/day, primarily clear fluids and small portions of fruit. No structured meal plan is in place. Compensatory behaviours including laxatives, purging, excessive exercise: * Excessive exercise (running 2 hours daily) Risks including mental health, self-harming behaviours, suicide: * Moderate risk of self-harm (scratching forearms with nail) * Passive suicidal ideation (wishes she wouldn't wake up) Neurodiversity, learning disability, or adjustments needed including gender preference, language difficulties, family dynamics: * No known neurodiversity or learning disability. * Family dynamics: High parental anxiety, some disagreement between parents regarding strictness of meal supervision. Physical health conditions including asthma, allergies, IBS: * No known physical health conditions. Medication: None. Assessment Height: 158 cm Weight: 35 kg Median BMI%: 14.0% (Red) Sitting BP: 90/60 mmHg Pulse (sitting): 45 bpm Standing BP: 65/45 mmHg Pulse (standing): 70 bpm Temperature: 35.8°C Behavioural Risk Indicators Any evidence of falsifying weight including water loading, hidden weights: Amelia admitted to drinking large amounts of water before weigh-ins in the past. Micro-exercising or compulsive movement patterns: Observed pacing and fidgeting during the session. Food disposal or hiding behaviours: Parents report finding food hidden in her room. Legal and Safeguarding Considerations Whether young person is Gillick competent or under parental consent: Amelia is not considered Gillick competent for medical decisions relating to her eating disorder due to impaired judgment caused by her illness. Parental consent is required. Any safeguarding concerns raised during assessment: Concerns regarding the rapid deterioration of Amelia's physical health and her self-harming behaviours. Whether Mental Capacity Act or Mental Health Act relevant to this case: Not currently applicable, but consideration if she continues to refuse treatment and her physical health further deteriorates. Other Additional context: Parents express significant distress and feel overwhelmed by Amelia's escalating symptoms. They are seeking intensive support and guidance. Based on the above, this young person is currently at: Overall MEED Risk Rating: Red Immediate actions required: * Urgent paediatrics referral for admission and stabilisation. * Same-day bloods (FBC, U&Es, Mg, Phos, LFTs, Glucose). * Inpatient consideration for refeeding and close medical monitoring. Recommendations "Please could this young person be seen in A&E for a physical health assessment using MEED." Date and details of next review in clinic with CAMHS: Scheduled for 03/11/2024 at 10:00 for specialist eating disorder assessment. MEED Risk Assessment Weight and BMI Weight for height percentage: <70% (Red) - Amelia's weight is significantly below the 5th percentile for her age and height. Rate of weight loss: >1kg/week for 2 weeks (Red) - 10 kg loss over 3 months, equating to approximately 0.8 kg/week, but with acute acceleration in the last month. Cardiovascular Pulse when awake: <40 bpm (Red) - Current sitting pulse of 45 bpm, with previous recordings as low as 40 bpm. Repeat observation consistently low. Postural pulse change: >30 bpm increase (Red) - Significant increase from 45 bpm sitting to 70 bpm standing (25 bpm increase), indicating orthostatic intolerance. Blood pressure systolic/diastolic: <0.4th centile (Red) - Sitting BP 90/60 mmHg (below 5th centile). Postural drop >15 mmHg systolic or >10 mmHg diastolic (Amber). Syncope episodes: Occasional (Amber) - Reports dizziness, no full syncope but presyncope episodes are frequent. Hydration and Fluid Intake Fluid intake: Severe restriction or 5–10% dehydration (Amber) - Significant restriction, estimated at 500ml/day. No overt signs of severe dehydration, but reduced turgor. Temperature Temperature: <36°C (Amber) - Consistent temperature of 35.8°C. Previous readings also low. Nutrition and Intake Daily calorie intake: <500 kcal/day for 2+ days (Red) - Estimated daily intake below 400 kcal for the past week. Food refusal: Severe restriction (Amber) - Active refusal of most food groups, with only minimal intake of 'safe' foods. Biochemical Abnormalities Electrolytes, glucose, albumin, WCC, Hb: Significant abnormality including low phosphate, potassium, calcium, sodium, glucose, albumin, WCC, Hb <10 (Red) - Awaiting urgent blood results, but high suspicion given clinical picture. SUSS Test Score SUSS score: 0–1 (Red) - Score of 1, indicating high risk. Exercise Behaviour Exercise level: >2h/day (Red) - Engages in 2 hours of running daily, despite physical weakness. Micro-exercising if present: Pacing and restless movements are frequent. Purging Behaviour Frequency and type of purging: Bingeing (Green) - No evidence of purging behaviours. Falsifying weight including water loading, weights, food disposal or hiding: History of water loading before weigh-ins. Food hiding also reported. Psychiatric Risk Self-harm or suicidal ideation: Moderate–high risk (Red) - Passive suicidal ideation and minor self-harm present. Other Clinical Concerns ECG abnormalities: Long QT or other significant findings (Red) - ECG shows prolonged QTc (480ms), requiring immediate medical attention. Physical struggles with carers over nutrition: Present (Red) - Parents report daily struggles and arguments over food intake. Family/Carer Dynamics Family anxiety: High. Disagreements over treatment: Parents have differing views on the level of strictness required for meal supervision. Need for psychoeducation and support: Significant need for psychoeducation on eating disorders and support for managing meal times. Family/carer involvement and support plan: Parents fully involved, require detailed support plan for meal supervision and crisis management to be developed in the "Plan and Next Steps" section. Plan to include family therapy sessions.