Background:

The Covid-19 pandemic has exacerbated the burden on the NHS with an unprecedented demand for healthcare services, prompting local innovations and new ways of working, and transforming the way health and care services work together. The South Warwickshire Frailty Admission Avoidance in the Community pathway (SW FAAP) is an integrated care model piloted in South Warwickshire NHS Foundation Trust during the first wave of COVID-19. This intervention was in response to a pattern of ambulance transfer of frail older patients to hospital who had low acuity medical illness and could be managed at home with enhanced community support. 

The SW FAAP care model involves the West Midlands Ambulance Service, a Community Integrated Single Point Access (ISPA) and the frailty assessment unit in the hospital working together to assess frail elderly patients to determine if hospital admission was required or if a visit from the community team was appropriate. The pathway entails the ambulance service calling the ISPA from a patient’s home to discuss the patient’s condition for joint decision regarding the appropriate care. These calls are received by senior nurses who in turn have access to the patients’ electronic record through the West Midlands Ambulance Service online patient dashboard, as well as direct access to consultants in the frailty assessment unit in the hospital. 

This pathway therefore potentially reduces the conveyance of older patients with frailty to hospital by providing an alternative to hospital to for frail patients who do not require acute medical care through enhanced support from community teams with input from secondary care. Evaluation of this care model as it evolves will support an evidence-based approach to build knowledge and inform decision making to improve delivery and enable replication.

Aims and Objectives:

This study aims to conduct a formative evaluation of South Warwickshire’s Frailty Admission Avoidance pathway in order to establish the progress of the care model and suggest ways in which its development and implementation model can be improved. 

Objectives

1. To gain an understanding of the components and scope of the SW FAAP intervention

2. To describe how the intervention is being implemented (process of implementation) and describe them using TIDierR (Template for Intervention Description and Replication) guidelines(9)

3. To assess the proportion of patients registered to the model and the proportion of these who are nevertheless admitted to hospital

4. To explore the barriers and facilitators of implementation

5. To consider and explore further improvement of the intervention

This study is part of the wider project ‘Acute assessment and medical care without hospital transfer for older people living with frailty’.

Methods:

This is a mixed methods study comprising:

· Conversation with key informants and desk review of documentation describing model processes and standard operating procedures  

· Extraction and analysis of routinely collected data

· Semi-structured interviews with a range of stakeholders

· Focus group discussion with stakeholders using the nominal group technique

Main Results:

The study is at the data collection stage. 

Outputs will include a Rapid Insights Guide, an implementation guide to inform other integrated care systems within the region and beyond, a publication in peer review journals and a conference presentation. Findings will also be disseminated to patients and their carers through local patient groups using contacts of the PPI lead and as advised by our public contributor panel.