Improving acute care for older people at scale – the Acute Frailty Network

Abstract

Older people form a growing proportion and volume of those accessing urgent care. Non-specific presentations, multiple comorbidities and functional decline make assessment and management of this cohort challenging. Comprehensive Geriatric Assessment offers an evidence based framework to assess and mange older people, especially those with frailty. In this article we describe the CGA approach, underpinned by specific examples illustrating some of the key competencies required, and describe the role of the Acute Frailty Network (AFN). The AFN is a national improvement collaborative designed to support hospitals in delivering evidence based care for older people with frailty and urgent care needs. We describe the principles underlying the approach of the AFN, derived from working with over 20 hospitals, and some of the early successes.

Can the Clinical Frailty Scale on admission predict 30-day survival, postoperative complications, and institutionalization in patients with fragility hip fracture?

“…Two studies have demonstrated that frailty indices are predictive of short- 6 and long-term mortality 7 and hospital length of stay (LOS) 6 following hip fracture, but neither study examined whether frailty measures predict other clinically important outcomes associated with hip fracture, such as complications or institutionalization. In recent years, particularly in the UK due to the efforts of the Acute Frailty Network, 8 there has been widespread adoption of the Clinical Frailty Scale (CFS) in all older patients admitted to hospital. The CFS is an assessment of a patient’s frailty status based on the two weeks prior to their admission, and is only validated in those above the age of 65.…”

Implementation frameworks for polypharmacy management within healthcare organisations: a scoping review

“…Forty-six statements were developed on healthcare structures, processes and desired outcomes, with consensus defined at ≥ 80% agreement This was a consensus-based study and as such it sought to explore consensus in relation to the Donabedian approach of structure, process and outcome. The focus of the statements included; strategic development, change management and indicator measure and awareness raising for implementation Country: European Union Participants: Five members from each country (n = 28), giving 140 members The five included: one policy maker, two healthcare commissioners, one healthcare provider director level and one clinician (physician or pharmacist) Consensus was obtained for statements relating to: potential gain arising from polypharmacy management (3/4 statements); strategic development (7/7); change management (5/7) indicator measures (4/6); legislation (0/3); awareness raising (5/5); polypharmacy reviews (5/7); and EU vision (0/7) Not relevant for this paper Conroy et al [ 30 ] Improving acute care for older people at scale - The Acute Frailty Network (AFN) This descriptive paper covers different approaches used to achieve high quality care for frail older people with urgent care needs. The evidence base is summarized and the paper described how the Acute Frailty Network has set about delivering improvements at scale The AFN was designed using the Breakthrough Series Collaborative (BTS) approach, involving health and social care systems working with support by national clinical and improvement experts and sharing experiences through national networking events.…”

“…Two papers provided detailed descriptions of the characteristics of programs that addressed the care of frail older people but did not carry out data collection [ 30 , 31 ]. In terms of research design, the other 6 papers [ 17 , 26 – 29 , 32 ] mainly used qualitative methods including: interviews [ 17 , 27 , 28 ], focus groups [ 17 , 26 , 27 ] and Delphi consensus [ 29 ] and workshops [ 32 ].…”

“…Seven of the included studies were conducted between 2016 and 2020 [17,[26][27][28][29][30]32]. Studies included addressed mainly the management of polypharmacy.…”

“…They focused on: the availability of policies and guidelines on polypharmacy management in older people [26,32]; the characteristics of healthcare professionals' barriers and facilitators to polypharmacy management [26][27][28]; and the development of frameworks of interventions to facilitate the implementation and sustainability of polypharmacy management programs [17,26,29]. Two papers provided detailed descriptions of the characteristics of programs that addressed the care of frail older people but did not carry out data collection [30,31]. In terms of research design, the other 6 papers [17,[26][27][28][29]32] mainly used qualitative methods including: interviews [17,27,28], focus groups [17,26,27] and Delphi consensus [29] and workshops [32].…”