Embedding comprehensive geriatric assessment in the emergency assessment unit: the impact of the COPE zone
Editor – We read Taylor et al’s article (Clin Med 2016;16:19–24) with keen interest. The article mentions, that at the time of writing, the authors were unaware of similar service configurations in the UK.
Musgrove Park Hospital, Taunton opened up an Older Persons Assessment and Liaison (OPAL) unit in November 2015. Our unit appears similar to the COPE zone. OPAL is a 12-bedded unit within a 51-bedded acute medical admissions unit (AMU). We have a comparable multidisciplinary team structure and twice daily board rounds. We identify patients aged over 75 years for the unit who have markers of frailty. We agree with the authors that it is difficult to create validated basic screening tools and current practice often relies on clinical discretion. Frail older patients who are transferred to a non-OPAL bed are also referred and assessed by our team. We have analysed our data for the first 2 months of working and found similar direct discharge home percentages from OPAL to the article data. Interestingly, post OPAL commencement, our average length of stay of patients treated in an OPAL unit bed reduced from 9.7 to 5.8 days in the over 75-year-olds. We note that, unlike the article, we had no formal daily geriatrician input to AMU prior to OPAL initiation. In line with the COPE zone, we currently provide a 5-day service but plan to expand to a 7-day service.
We think that this shows that the benefits are reproducible and would encourage other hospitals to consider such a service.
- © 2016 Royal College of Physicians
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