Our work improving care for older people wins HSJ award

19-September-2023

We’re pleased to announce our work improving care for older people has won a HSJ Patient Safety Awards 2023.

The Acute Frailty Network (AFN) was created to support older people living with frailty get home sooner and safer from acute hospital. We have worked with 144 hospitals to overhaul how older people are cared for - leading to positive improvements, such as reduced length of stay, improved hospital mortality and better patient experience.

Older patients were vulnerable to harm and delays

Older people living with frailty are especially vulnerable to harm and delays in urgent care. According to the Silver Book, the first 72 hours are critical to ensure a swift recovery and reduce harm.

Comprehensive Geriatric Assessment (CGA) is a holistic evaluation of older patients, using a coordinated, team-based care approach. Substantial evidence shows that patients who receive a CGA are more likely to return home quickly, and less likely to have cognitive or functional decline (Ellis et al., 2017).

However, back in 2015, many hospitals did not have a system to identify older people with frailty and CGA was not commonplace. We wanted to improve care by firstly working with hospitals to adopt the Clinical Frailty Scale (Rockwood). Next, we supported teams to use CGA for appropriate patients, which helped speed up discharge. We used the latest research and front-line evidence to bring about system and policy changes.

Improving outcomes for patients across 144 hospitals

Over the last eight years, we have supported 144 hospitals to improve the quality of care, using a mix of guidance, site visits, collaborative events, and opportunities to co-design improvements. Each hospital has developed and designed the initiative with its front-line teams.

The programme has already led to positive outcomes, hospitals in the network have reported improvements such as:

• 38% reduction in admissions
• 54% reduction in the length of hospital stay for patients
• 35% reduction in frail older people who are hospitalised for over ten days
• Up to £30.5 million – the predicted total saving through bed costs for all participating sites combined
• 73% of hospitals assessed frailty within 30 minutes of patients arriving at hospital, and most had a form of front door frailty service in place

Despite evidence showing poor outcomes for older people with frailty, hospitals were not tracking this information. To address this, we created the Hospital Frailty Risk Score, allowing commissioners and providers to understand frailty across their system.

The AFN team in conjunction with Professor K Rockwood have also designed and published a ‘CFS app’ freely open to anyone internationally. This means front line staff can easily identify the level of frailty older people have within seconds of their first assessment.

Raising awareness of frailty in care globally

Over 3,000 people have come to the AFN for guidance on this important topic, and we have seen that frailty in urgent care is a global issue. Internationally, based on this work, structural changes have been made in Australia, Malaysia, Singapore, Canada and Ireland. We will continue to raise awareness of frailty to support the safety and care of older people.