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.