Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Older Persons Assessment Service (OPAS): delivering comprehensive geriatric assessment in the emergency department

Alexandra J Burgess, Elizabeth A Davies, David Burberry, Catherine Beynon-Howells, Patricia Quinn, Lucy James, Caryl Hopkins, Amanda Mdhlongwa, Danielle Davies and Debra Clee
Download PDF
DOI: https://doi.org/10.7861/clinmed.22-4-s80
Clin Med July 2022
Alexandra J Burgess
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Elizabeth A Davies
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
David Burberry
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Catherine Beynon-Howells
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Patricia Quinn
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Lucy James
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Caryl Hopkins
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Amanda Mdhlongwa
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Danielle Davies
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Debra Clee
AMorriston Hospital, Swansea, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
Loading

Introduction

Innovative models of service delivery are required to provide comprehensive geriatric assessment for older patients presenting to the emergency department (ED) with frailty syndromes. Out of 139,636 attendances in 2020–21 to the ED at Morriston Hospital, Swansea, 3,906 were due to falls in patients aged >65 years.

In patients aged >80 years, 41.6% of these were admitted in 2018–2020, and readmissions to ED occurred in 24%.

Method

Phase 1: In 2018, the Older Persons Assessment Service (OPAS) began a liaison service to the ED, taking referrals from the medical and ED teams for patients who presented with frailty syndromes (falls, cognitive impairment, care dependence, polypharmacy). The service saw 437 patients between April and August 2018. 76% of the patients assessed were discharged by utilising available community services, rapid access outpatient follow-up and inpatient re-ablement off the acute site. The service was estimated to avoid 50–80 admissions per month to medicine (Fig 1; Table 1), saving 17–23 beds a year, and was commissioned as a permanent service.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

Emergency admissions to medicine by month.

View this table:
  • View inline
  • View popup
Table 1.

Admissions 2017/2018

Phase 2: In 2020, a dedicated unit within the ED was allocated to OPAS, enabling the acceptance of patients directly from triage and from the ambulance service. This provided rapid access to specialist assessment and continued access to elderly care services, and avoided exposure to coronavirus-related admissions and the risks of nosocomial infection associated with admission. The service operated from 8am–4pm on weekdays.

Results

Between June 2020 and December 2021, the service saw 1,302 new patients (950 presenting with falls). 1,087 patients (83.5%) were discharged from the acute site on the day of assessment. 69 (5.3%) patients were admitted to other facilities run by the health board (eg inpatient re-ablement). The average age of an OPAS patient was 83 years and they had a Clinical Frailty Scale score >5 on average. The readmission rate at 14 days was 55 (5%). Of the 284 patients who were admitted to an inpatient setting, 35 (12.3%) contracted nosocomial COVID-19.

Conclusion

This service demonstrates the ability of consultant-led multidisciplinary services that provide comprehensive geriatric assessment in the emergency department to avoid hospital admissions and readmissions. This study has been able to demonstrate a greater measurable impact on these service metrics than has been previously published.1–3 The team has secured investment and now functions 7am–7pm on weekdays, with plans for future weekend working.

  • © Royal College of Physicians 2022. All rights reserved.

References

  1. ↵
    1. Ellis G
    , Jamieson C-A, Alcorn M, Devlin V. An Acute Care for Elders (ACE) unit in the emergency department. Eur Geriatr Med 2012;3:261–3.
    OpenUrlCrossRef
  2. ↵
    1. Conroy SP
    , Ansari K, Williams M, et al. A controlled evaluation of comprehensive geriatric assessment in the emergency department: the ’Emergency Frailty Unit’. Age Ageing 2014;43:109–14.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Keyes DC
    , Singal B, Kropf CW, Fisk A. Impact of a new senior emergency department on emergency department recidivism, rate of hospital admission, and hospital length of stay. Ann Emerg Med 2014;63:517–24.
    OpenUrlCrossRefPubMed
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Older Persons Assessment Service (OPAS): delivering comprehensive geriatric assessment in the emergency department
Alexandra J Burgess, Elizabeth A Davies, David Burberry, Catherine Beynon-Howells, Patricia Quinn, Lucy James, Caryl Hopkins, Amanda Mdhlongwa, Danielle Davies, Debra Clee
Clinical Medicine Jul 2022, 22 (Suppl 4) 80-81; DOI: 10.7861/clinmed.22-4-s80

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Older Persons Assessment Service (OPAS): delivering comprehensive geriatric assessment in the emergency department
Alexandra J Burgess, Elizabeth A Davies, David Burberry, Catherine Beynon-Howells, Patricia Quinn, Lucy James, Caryl Hopkins, Amanda Mdhlongwa, Danielle Davies, Debra Clee
Clinical Medicine Jul 2022, 22 (Suppl 4) 80-81; DOI: 10.7861/clinmed.22-4-s80
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Introduction
    • Method
    • Results
    • Conclusion
    • References
  • Figures & Data
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Reduction of home-acquired pressure ulcers among palliative patients using quality tools and techniques
  • FIT and the endoscopy service in Swansea Bay Health Board during the COVID-19 pandemic
  • Improving compliance to DEXA in IBD population according to BSG guidelines in Morriston Hospital, Swansea
Show more QUALITY IMPROVEMENT AND PATIENT SAFETY

Similar Articles

FAQs

  • Difficulty logging in.

There is currently no login required to access the journals. Please go to the home page and simply click on the edition that you wish to read. If you are still unable to access the content you require, please let us know through the 'Contact us' page.

  • Can't find the CME questionnaire.

The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. RCP members and fellows (using their login details for the main RCP website) are able to access the full SAQ with answers and are awarded 2 CPD points upon successful (8/10) completion from:  https://cme.rcplondon.ac.uk

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians