Acute Frailty Network (AFN) – Improving services for frail older people

" People aged 65+ accounted for an estimated 20% (3.6 million out of 18.3 million) of first attendees to English Emergency Departments (ED) in 2012/13; this population are more are at high risk of hospital admission following an ED attendance” (Smith et al Nuffield Trust 2014)

The first 72 hours of a hospital admission are critical in terms of establishing an accurate initial decision to admit and rapidly establish a problem list and management plan (RCP Future Hospitals 2013).

A growing body of evidence suggesting that ‘hospital at home’ for selected patients offers significant advantages in terms of lower mortality and reduced functional decline. However, once admitted to hospital, it becomes increasingly difficult to arrange early supported discharge for older people due to a variety of clinical and organisational barriers.

Acute Frailty Delivery Network

The purpose of the Acute Frailty Network is to optimise acute care of frail older people in England, but no one model will fit all systems, although the guiding principles can be derived from the existing evidence base, and locally adapted.

The Acute Frailty Network (AFN) is designed using the ‘collaborative improvement’ model; this approach involves health and social care systems working to improve services locally, supported by national clinical and improvement experts sharing their experiences through national networking events. The network team will deliver four national events and a set of masterclasses and webinars that support participating teams in delivering improvements to local acute frailty services and enable teams to share experiences with one another. Each participating team will have acces to a team of national clinical experts as well as an allocated ‘ service improvement coach’ and access to measurement expertise to plan and support the redesign of services .

The first wave of the Network was launched in January 2015 and will run for 12 months.  Health and social care systems were invited to take part in order to represent the range of perceived quality of their acute services for frail older people.

Each programme runs for 12 months and participating trusts are supported in a number of ways. The support includes;

  • 4 National events (8 places at each event)
  • Topic specific master classes
  • Webinars
  • Site visits
  • 1-1 help as needed
  • Expertise on measurement
  • A Return on Investment calculator
  • Measuring patient experience and using experience based design to improve services
  • Sustainability assessment
  • Members web resource repository for all outputs from the programme from participating sites

A large portion of the programme is delivered remotely but there are a number of physical events. These are;

  • Four National Events (1 every 3 months)
  • Measurement master class
  • Nursing Masterclass
  • Two EBD workshops
  • Improvement methodology

Objectives

·         The proportion of the ten health and social care communities who have tested and implemented new models of urgent care for frail older people and who can showcase their work to the wider NHS

·         To establish a repository of best practice and case studies from the pilot sites, describing their work and lessons learnt, to support spread

·         To describe a bundle of tools and methodologies to support the implementation of AFN locally

·         To prepare a set of national guidance on how to implement better models of care that reduce hospital admissions and length of stay; that improve experience and outcomes for older people

·         To outline a ‘Return on Investment model’ that supports local implementation of AFN