257 - Clinician Perspectives of Eating Disorder Screening in the Pediatric Emergency Department

Publication Number: 3247.257

Amy D. Thompson, Sidney Kimmel Medical College at Thomas Jefferson University, Wilmington, DE, United States; Claire Loiselle, Nemours Children's Hospital, Wilmington, DE, United States; Talia Gillespie, Nemours Children's Hospital, Wilmington, DE, United States; Mackenzie Seymour, Nemours Children's Hospital, Wilmington, DE, United States; Ime Nkanta, Nemours Children's Hospital, Wilmington, DE, United States; Hayley Goldner, NemoursAlfred I. duPont Hospital for Children, Media, PA, United States; Kidian Martinez, NemoursAlfred I. duPont Hospital for Children, Wilmington, DE, United States; Alexandra Taylor, Nemours Children's Hospital, Wilmington, DE, United States

Background: Eating disorders affect approximately 5% of adolescents, and early identification improves recovery outcomes. Although annual screening by primary care providers is recommended, low rates of preventive visits among adolescents result in missed opportunities for detection. Utilizing the emergency department (ED) as a screening site may enhance early diagnosis and intervention for eating disorders.

Objective: 1.) To assess clinician attitudes towards screening for eating disorders in the ED. 2.) To describe the perceived barriers and facilitators identified by clinicians for implementing eating disorder screening in the ED.

Design/Methods: We conducted a qualitative study using semi-structured interviews with clinicians from three tertiary care pediatric hospitals. Participants were recruited via purposive sampling and included pediatric emergency medicine (PEM) physicians, PEM nurses, PEM social workers, general pediatricians, and eating disorder clinic team members. An expert panel of PEM physicians and eating disorder specialists designed the interview guide, structured around the Theoretical Domains Framework (TDF). Interviews explored clinician perspectives on the feasibility, acceptability, and perceived usefulness of an ED-based eating disorder screening tool, as well as best practices for implementation. Recruitment continued until thematic saturation. Transcripts were analyzed thematically using template analysis. Two researchers independently coded each transcript and met regularly to resolve discrepancies and refine the coding framework.

Results: A total of 38 interviews were completed (Table 1). Important themes were identified across 11 domains of the TDF (Table 2). Most clinicians viewed eating disorder screening as an important goal, noting that the ED often serves as a primary point of care for adolescents. The environmental context and resources available at different hospital systems greatly influenced clinician perceptions on feasibility. Lack of referral pathways was identified as a key barrier while integration with existing self-administered mental health screeners was seen as a potential facilitator.

Conclusion(s): Although emergency medicine clinicians reported limited knowledge of eating disorder screening, they recognized its importance and expressed optimism that, with appropriate resources and training, screening could be implemented in the ED setting. Using the TDF frameworks, future implementation tools can be mapped to identified barriers. Collaboration with eating disorder clinic team members and general pediatricians will be essential to support effective integration.

Table 1: Distribution of Interview Participants by Role and Hospital Site
Table 1 Distribution of Interview Participants by Role and Hospital Site.pdf

Table 2: TDF Domains with Corresponding Questions, Selected Themes, and Illustrative Quotes
Table 2 TDF Domains with Corresponding Questions, Selected Themes, and Quotes.pdf