We need to talk about PJs

Last week, ASPH launched its very own End PJ Paralysis campaign.  If you are not familiar with the campaign you can read more about it here – https://www.england.nhs.uk/blog/jane-cummings-32/

The ASPH campaign was a success in raising awareness of a really important issue for patient care; but also in bringing teams together, harnessing their creativity and using social media to spread the word.  It was also a great reminder for us that, when presented with some evidence and set a challenge of making a difference for patients (even at a time of increasing demands and pressure in our systems) the teams at ASPH are capable of some amazing things.

In this blog, Dr Keefai Yeong (Ortho-Geriatrician and Clinical Lead for QI) writes more about the campaign and the learning.


The concept of deconditioning is well known to most geriatricians. “Bobby” Irvine, the founder of orthogeriatric medicine, coined the phrase “…bedrest is rehabilitation for the grave.” alongside his orthopaedic counterpart, Michael Devas, in Hastings back in the 1960s.  Even earlier than that, in 1947, Richard Asher wrote a landmark paper in the BMJ entitled “The Dangers of Bedrest”, where he wrote, “Teach us to live that we may dread, unnecessary time in bed; Get people up and we may save, Our patients from an early grave.”

It is reported that older persons can spend up to 83% of their time in the hospital sitting in bed. So why is it that we see so many patients in bed in modern hospitals?

Sadly, as medical knowledge advances, we became more reliant on medications and procedures to make our patients better, and the issue of maintaining function became a secondary issue.  The issues contributing to this may include a depleted nursing, medical and therapy staff on the wards, and an increasing number of frail elderly patients on the wards.

Lack of physical activity leads to a disorder called deconditioning, and it can lead to a plethora of symptoms for which we are only too happy to prescribe medications for, e.g. constipation and depression.  However, the biggest issue with bedrest is, by far, disuse atrophy.

An older person can lose up to 10% of their muscle strength if they are confined to bed for a week or put another way, a 10-day stint in bed can lead to an equivalent of 10 years of muscle ageing in someone over the age of 80. For the patient, this is the difference between dependence and independence.

The Campaign

These are the reasons we are embracing the #EndPJParalysis campaign here at ASPH.  This brilliant campaign was started on social media by Professor Brian Dolan and the nursing staff at Nottingham University Hospital FT (NUH), including Ann-Marie Riley, the Deputy Chief Nurse.

Since then, the campaign has spread regionally, nationally and internationally, and in April of this year, it was estimated that the campaign had over 23 million Twitter impressions across the world.

The message of the campaign is simple – prevent deconditioning in the hospital by encouraging patients to maintain some normality whilst in the hospital and to get up, get dressed and be active.

Our campaign at ASPH took off in much the same way as the initial campaign in Nottingham – via social media. A group of interested staff members, from diverse backgrounds, started discussing the campaign on Twitter, which led to the formation of a working group called #ChangeTheWorld at ASPH.

The group met weekly, and with the help of the Be The Change team, organised a week of activities to promote the campaign and to raise awareness of the dangers of bedrest in our hospitals.  For our campaign, we asked all the wards to hold a pyjama party, where the staff would encourage patients to get dressed in their own clothes and the staff themselves will come to work dressed in their PJs!

The idea was well received, and 12 wards, across the medical and surgical specialties, held parties to celebrate and highlight the campaign. I was struck by how imaginative some staff were, and we had some brilliant ideas including a patient cinema on Holly Ward with a hospital sheet as the screen, a skeleton dressed as a ward sister on Swan Ward and a Macarena in PJs rendition by staff  on Falcon!

The team also promoted the campaign throughout the hospital and spoke to patients, staff and visitors about the importance of getting dressed and getting active. For those willing, we asked them to sign a pledge to help #EndPJparalysis.

Harnessing Social Media

The impact of the #EndPJparalysis campaign will not be known for some time.  We know that, during the week raising awareness alone, we saw a significant reduction in the use of gowns by patients and more patients were discharged from our wards than in previous weeks.  But this campaign is about more than just one week, and changing bahaviours and traditional ways of working takes time.


For me, the campaign was another reminder of the power and reach of social media as a force for positive change in the NHS.  The #EndPJparalysis campaign has spread between organisations via Facebook and Twitter, and the growing number of Twitter users in our own hospitals (from the Chairman to the front-line staff) help to share ideas and thinking in a way that traditional meetings could never do.

Perhaps we should be thinking more about how we can use social media and messaging for quality improvement; and using this to better harness the curiosity and creativity of our teams when it comes to tackling other issues that effect patient safety and patient experience?


I hope that everyone enjoyed being part of our #endPJparalysis activities through the week and that this has inspired you to help your patients get better faster. If you have any queries, or want to become part of our #ChangetheWorld team, please feel free to get in contact.

Finally, we have invited Professor Brian Dolan to come and talk to us on the 23rd of October about the campaigns he has been involved with.  There are limited spaces available for the whole day event, so if you have been inspired by the campaign so far, and want to know more from the founder himself, please get in touch via bethechange@asph.nhs.uk


Dr Keefai Yeong – @KFY98

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