Increasing the levels of physical activity of patients on an acute medical ward, incorporating a motivational interviewing approach

Purpose

This project forms one part of the Active Hospital pilot at Oxford University Hospitals Foundation Trust, which was supported by Public Health England and funded by Sport England. It aims to explore the feasibility of a multi-disciplinary team, led by Sports and Exercise Medicine consultants, to embed physical activity (PA) within a secondary care environment. The acute medical ward was one of the pathways chosen as part of the pilot work. Levels of patient activity on the ward were very low and opportunities to be active were frequently missed. The existing therapy structure was such that priority was placed either on those with acute chest problems, or those due for imminent discharge, with very little opportunity for activity for those deemed to be of a lower priority. The risks associated with inactivity, particularly for older people whilst in hospital,are well documented and so this project aimed at improving PA levels for all patients. The objectives were to: - improve the levels of activity for all patients on the ward - improve staff's knowledge on the importance and benefits of physical activity - improve the effectiveness of conversations to support physical activity behaviour change

Approach

The pilot was able to fund a physical activity champion on the ward (in this case a B5 nurse) for 1 day per week, whom we supported to deliver the intervention, which included delivery of: -

- Exercise programmes, suitable to be carried out on the bed, in the chair or in standing

- 'I Can' enablement signage, which identifies mobility/functional level,as well as level of appropriate exercises

- Physical activity conversations underpinned by a motivational interviewing style

- Development of a mobility assessment tool to enable all staff to be able to support and encourage an appropriate level of activity on admission

- Development of a training resource for staff

Outcomes

Results: Delivery of the intervention was shown to be feasible and acceptable. Activity levels of patients improved when the clinical champion was present on the ward. All aspects were well-received across staff and patient groups. Learning from the pilot was evaluated externally and contributed to an online toolkit which aims to share learning across the NHS. Having shown feasibility, the medical wards have introduced a new, seven-day, Advanced Rehab Support Worker (ARSW) role, to promote PA on the ward and they will continue to deliver the bundle of resources developed as part of the pilot.

Conclusion(s): There is an appetite to improve levels of activity for older people on medical wards and having dedicated staff helps facilitate this. More detailed analysis of the impact of the ARSW is ongoing, with the ambition to develop this across other wards.

Cost and savings

£110,000 cost of 4ARSWs

Implications

In secondary care settings the literature specifically highlights the benefits of PA interventions:

· Reduction in length of stay

· Reduction in total hospital costs compared to usual care

· Fewer complications , eg reduction in Pulmonary embolism

· Increase in the number of patients discharged home at a pre-morbid level of independence

· Improved knowledge and confidence of staff to discuss PA with patient

Top three learning points

No further data 

Funding acknowledgements

The Active Hospital Project was commissioned by Public Health England, with funding from Sport England which funds my role as lead physiotherapist with the Active Hospital team. This funding also enabled us to support the Physical Activity Champion on the ward for the duration of the feasibility pilot as well as supporting the new ARSWs with online Motivational Interviewing (Active Conversations) training. A small bids grant from Oxford Hospital Charities enabled us to purchase exercise equipment to support physical activity on the ward and to develop an exercise video to complement the exercise booklets.