Problem Older Victorians experience variable frailty-focused care. Models fail to capture frontline expert input or deliver coordinated, system-level interventions. Where effective programs exist (e.g GEDI), impact is limited by reactive workflows, siloed action, and weak integration with whole-of-hospital decision-making. This variability constrained improvement in outcomes for older persons.
Design & Methods An Improvement Collaborative united 13 Victorian hospitals to redesign care for older persons (≥65 years; ≥50 years for First Nations peoples). Rather than mandate a single model, the collaborative created a structured platform for peer learning, common data visibility, and iterative local testing. Clinical leaders were supported to work at top of scope, shifting from location-based practice to influencing whole-of-pathway redesign.
Practice Change Early progress reflected isolated pockets of excellence. Acceleration occurred when teams reframed unnecessary waiting—including avoidable admissions—as a modifiable source of harm and positioned timely intervention as core. Shared data strengthened understanding of the continuum of the older person’s journey. Collaborative exchange accelerated spread of effective practices and exposed limitations of narrowly focused “front door” models.
Re-audit Across 18 months, participating services achieved sustained reductions in admission rates (2.6% absolute; 5% relative -prior 12 months) and inpatient LOS (~2,500 fewer admissions and estimated 60,000 bed days saved) These gains occurred without evidence of increased harm, including ED LOS or readmissions.
Conclusions An adaptive collaborative approach catalysed system-wide learning and measurable impact, particularly where anticipatory expert review was embedded. Work continues to strengthen links between front door frailty models and assertive inpatient case management.