Emergency departments and critical care units are very busy areas with a high turnover of patients, as well as the urgency of care provided with even smaller details matter in routine patient management. There should be strong efforts to improve the quality of patient care and to reduce medical errors, which are dangerous in such complex and busy areas. Thus, to support safe, effective care and closed-loop communication, patient medical records should be up to date so that timely care should be provided in emergency departments and ICU. Different protocols, standard operating procedures, checklist and physician rounds are all part of the attempt to improve clinical care. Very strict care is mandatory irrespective of the cause in critically ill and emergency patients. For the same, a shortened mnemonics for remembering elements of routine care is very important both in the emergency department and ICU. This is very important in daily clinical rounds.
In 2005, Jean Vincent came up with FAST HUGS, an abbreviated mnemonic for remembering important issues to look for in critical patients. It was basically a CME exercise from its origins and developed into an interesting article (1).
Subsequently, after four years, it became a valuable tool, and Vincent and Hatton upgraded the mnemonic to FAST HUGS BID in 2009 by including additional components of spontaneous breathing trial, bowel care, indwelling catheter removal and de-escalation of antibiotics (2).
- Feeding/fluids
- Analgesia
- Sedation
- Thromboprophylaxis
- Head up position
- Ulcer prophylaxis
- Glycemic control
- Spontaneous breathing trial
- Bowel care
- Indwelling catheter removal
- De-escalation of antibiotics
Chris Nickson on Life In The Fast Lane Critical Care Compendium (CCC) expanded it further to FAST HUGS IN BED Please, with additional environmental control for delirium, a reminder to de-escalate therapies finishing it with psychosocial support (3).
FAST HUGS IN BED Please
- Fluid therapy and feeding
- Analgesia, antiemetics, and ADT (AAA)
- Sedation and spontaneous breathing trial
- Thromboprophylaxis
- Head up position (30 degrees) if intubated
- Ulcer prophylaxis
- Glucose control
- Skin/eye care and suctioning
- Indwelling catheter
- Nasogastric tube
- Bowel cares
- Environment (e.g., temperature control, appropriate surroundings in delirium)
- De-escalation (e.g., end of life issues, treatments no longer needed)
- Psychosocial support (for patient, family, and staff)
The above version was meant and applied in the emergency department or the intensive care unit as per Dr. Chris Nickson, last update July 23, 2019:3
Finally, this same concept can be easily applied in the emergency department as a modification FAST HUGS IN BED ED.
FAST HUGS IN BED ED will help both undergraduate medical students and residents in emergency medicine and critical care to revise and remember important areas of care. This has enormous benefits in a busy emergency resuscitation room as well as in complex ICU care settings.
References and Further Reading
- Vincent, Jean-Louis. “Give your patient a fast hug (at least) once a day.” Critical care medicine 33.6 (2005): 1225-1229.
- Vincent, William R., and Kevin W. Hatton. “Critically ill patients need “FAST HUGS BID”(an updated mnemonic).” Critical care medicine 37.7 (2009): 2326-2327.
- Dr. Chris Nickson, last update July 23, 2019, Life in the Fastlane – https://litfl.com/fast-hugs-in-bed-please/
