Operationalising adult eating disorders admission criteria in Australian emergency departments: a clinical decision-support approach.

Emergency departments operate under conditions that constrain clinical decision-making, including high patient volume, time pressure, workflow disruption, frequent interruptions, and variability in clinician experience. Eating disorders present a particular challenge within these settings because assessment requires integration of physiological, biochemical, behavioural, nutritional, mental health, and psychosocial risk factors, many of which may not be immediately apparent even during acute presentations. Although guideline-based admission criteria exist, their application requires clinicians to synthesise and cross-reference heterogeneous clinical information in real time, which may contribute to variability in decision-making and risk of unsafe discharge. This paper examines eating disorder-related emergency department practice as an operational implementation problem, drawing on existing literature, clinical guidelines, and lived experience perspectives to identify why established adult eating disorder admission criteria may be difficult to apply consistently in acute care settings. Based on this analysis, a clinical decision-support framework is proposed to operationalise existing guideline-based admission criteria within emergency department workflow. The framework is intended for use after initial triage, when clinical observations, biochemical findings, behavioural information, mental health risk, psychosocial context, and response to outpatient treatment are reviewed, and before final admission or discharge decisions are made. It is designed to support more consistent and transparent assessment of risk by organising clinical input across key domains and mapping these inputs directly to established admission criteria. This is intended to support clinical judgement by increasing visibility of clinically significant risk factors and prompting documentation when decisions diverge from guideline-based recommendations. As a proposed framework, empirical evaluation is required to determine feasibility, usability, implementation barriers, clinician acceptability, and potential effects on decision-making, clinical outcomes, and patient safety.