Developing frailty friendly hospitals: the Specialised Clinical Frailty Network.

Introduction: The aim of the Specialised Clinical Frailty Network (SCFN) was to develop frailty-attuned pathways in specialised services in England. Methods: We developed a breakthrough series collaborative involving a range of specialised services, using quality improvement methods (including experience-based design) to implement improvements designed to enhance the experience and outcomes of older people living with frailty who have specialised healthcare needs. Results: Specialised teams responded positively to the SCFN, many implementing process changes aligned to the needs of older people living with frailty. Some were able to demonstrate improvements in service and/or patient outcomes, including greater identification of frailty, more holistic care and increased use of shared decision making. Discussion: The network has successfully demonstrated how frailty can be assessed both at individual, as well as population level, to support both local teams and systems to best manage the health of their patients.

Analysis of the Experience-Based Design Feedback Data on a National Scale.

The United Kingdom Office of National Statistics population estimates that 10 million people are aged 65 years and older, of which some would be considered frail. This is conceptualized as a complex progressive loss of physiological and social function. In order to establish and evaluate appropriate services, feedback tools designed for this patient group have begun to take greater importance, which the Acute Frailty Network has been developing using experience-based design. These tools focus on the experience of frail patients in the settings of accident and emergency and the acute medical unit. An analysis of data from 12 hospitals was used to look at the common emotions and comments expressed at the key touchpoints. A total of 609 respondents were used in the analysis, revealing that patients expressed mostly positive experiences. The areas with the most negative emotions and comments were in the domains "being admitted," "first assessment," and "preparing to leave hospital." We would recommend that future quality improvement projects focus in improving the communication standards around the admission and discharge process.

The Acute Frailty Network: experiences from a whole-systems quality improvement collaborative for acutely ill older patients in the English NHS.

Older people form a growing proportion and volume of those accessing urgent care, much of which is provided by non-specialists in geriatric medicine. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. In this article we describe the approach and methods of the Acute Frailty Network (AFN), a national quality improvement collaborative designed to support acute hospitals in England to deliver evidence-based care for older people with frailty. We report on 3 years' experience of whole-systems quality improvement through the network. Using local case studies, we illustrate initiatives through which AFN hospitals improved services and outcomes for older people with frailty and urgent care needs. We describe returns on investment and sustainability of implementation, and reflect on future directions for the AFN.