Tying in with #endPJparalysis the campaign will help to prevent loss of muscle strength, promote a speedier recovery, help patients get home sooner and save lost time to the 999 system. To support the campaign, we've designed posters that you can use to promote #Fit2Sit across your ambulance services and emergency departments.
Download and print our posters to use in your organisation and help get patients home sooner.
Why I'm backing the #Fit2Sit campaign
Our Emergency Care Improvement Programme (ECIP) Ambulance Advisor and member of the Q Community, Dave Ashford, tells us why he is backing the #Fit2Sit campaign which aims to put a stop to patients lying down on trolleys or stretchers if they are well enough to sit up or walk.
Why do we need a new approach?
As part of my day job, I recently conducted what is called an ‘emergency department (ED) ambulance handover review.’ As with many of the reviews we undertake, I quickly noted that all patients who came into majors ended up on a hospital trolley. The department very quickly became full. Staff became despondent - and critically - ambulances began queuing to get into the ED. The worrying thing about this is how quickly the community can become deprived of its 999 service.
Seeing the potential of #Fit2sit
Whilst at the department, I took a keen interest in two patients. The first was a young male patient who had fractured his tibia while having a fit. He was quite uncomfortable sitting on the trolley, and at every opportunity he asked the nursing staff if he could stand up. Just prior to his discharge at four and a half hours, I noticed that he had let the trolley’s side down and was sitting with his legs over the side of the bed. He walked (well, hobbled) out of the department. His presenting symptoms were treated within 60 minutes. The remaining time was spent waiting for his relatives to collect him.
The second patient was a lively 86 year old lady with a chest infection, who required antibiotics and an admission. Six and a half hours later I helped the porter push her trolley to the ward. Upon arrival the nursing staff handed over; then the nurse asked the patient where she would like to sit. ‘On the chair’ replied the patient. She swung her legs over the side of the trolley and with some assistance stood up. Thanking both me and the porter, she then said: ‘I’m glad to be off there. My backside was killing me!’ Up to this point, I had presumed the patient couldn’t walk as she had arrived on a stretcher by ambulance. No one had assessed her mobility.
Clearly, for these two patients #Fit2Sit would have made a real difference. It also would have freed up a couple of trolleys, a porter and perhaps some lost time to the 999 system.
It worries me that by failing to properly assess their mobility, we may be causing muscle loss in our patients, especially frail older people. In ED, patients can wait for long periods for the next thing to happen, and in some cases they wait on trolleys. The good news is that we can all pull together as a team to encourage patients to develop a recovery mind-set from the outset – staying mobile, and sitting up or standing when well enough.
In the ambulance service, we can do this by:
- allowing patients to be fully clothed – think of #Fit2Sit as the sibling of the #endPJparalysis movement
- encouraging patients to walk if they can, to prevent deconditioning
- using the wheelchair first, rather than a stretcher or trolley
- recording the time it takes to move a patient onto a bed
- having a clear plan for when and how the patient can be mobile
Nottingham University Hospitals NHS Trust is running the #Fit2Sit campaign in their Emergency Department already. They have introduced some simple but powerful initiatives, such as checking whether a patient is able to walk at every point of contact. Crucially, they are also embedding this into their board rounds and safety huddles in ED, so that patient mobility stays on the agenda.
I urge you to pick up the #Fit2Sit mantle and do the same - get your patients to walk, improve their fitness and muscle strength, regain independence and minimise waits in emergency departments. It could make all the difference to their ability to return to independent living.