Malnutrition, Weight Loss and Eating Disorders Clinical Pathway — ICU and Inpatient

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Goals and Metrics

Patient Education

Provider Resources

Related Pathway

Malnutrition (Undernutrition), Inpatient

Patients > 7 years old with suspected or diagnosed malnutrition, weight loss, and/or eating disorders

Frontline Ordering Clinician (FLOC)/RN Assessment
Order Consults

Low suspicion for disordered eating as primary diagnosis

High suspicion for disordered eating as primary diagnosis

Initiate nutrition intervention as needed (example: calorie counts or oral supplements)

Initiation of Nutritional Rehabilitation and Ongoing Care
- Use Nutritional Rehabilitation/Diet Order
Behavioral Health consult to confirm diagnosis

Continue medical work
up as necessary

If not progressing appropriately, consider Initiation of Nutritional Rehabilitation and Ongoing Care

Discharge Planning

Family Meeting
Home Hospital Education
- Nutrition
  Behavioral Health
Discharge criteria

Outpatient Care

Higher Level of Care

Family Based Treatment

Other Outpatient Care

Posted: October 2019
Revised: December 2020
Authors: J. Chuang, MD; E. Lantzouni, MD; R. Peebles, MD; J. Pletcher, MD; L. Morrow, PsyD; A. Timko, PhD; L. Weaver, MD, PhD; B. Higgins, RD; B. Waiters, LSW; A. Mariotz, MSN; S. Simon, MSN

Evidence

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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ICU and Inpatient Clinical Pathway for Evaluation/Treatment of Children with Malnutrition, Weight Loss, and Eating Disorders

Evidence