65 A review of the Older Persons Rapid Assessment Hub (OPRAH) in the Emergency Department (ED)

Abstract

Abstract Background The conventional paradigm of emergency care may not address the multifaceted care needs of older patients, who present to the emergency department with multiple comorbidities, geriatric syndromes, and health determinants, complicating diagnosis and therapy. OPRAH was introduced in 2019 to meet the needs of our changing population. The unit was initially developed out of existing resources within the ED but more recently expanded with the addition of a Geriatric ANP, additional ED GEM (Geriatric Emergency Medicine) consultants, an occupational therapist and a physiotherapist to the team. Methods The electronic records of all patients seen by the OPRAH team were reviewed to determine the impact of the service. The data collected included the patient’s age and outcome of the patient (admission vs discharge). Results From 1st of January to 30th of April 2023, 1,118 patients were assessed. Three hundred and forty patients were admitted to a hospital (30.41%). Of those, 264 patients were admitted to X (23.61%), 64 to Y (5.72%), 10 to Z (0.89%) and two patients in A (0.17%). The remaining patients were either discharged back home or referred to convalescence in a nursing home. The mean age was 82, ranging from 35 to 103. Conclusion The expansion of OPRAH in the ED has improved access for all patients living with frailty to short-stay ED-led care. The implementation of integrated care had led to patient-centred care with the timely discharge of suitable patients to either their own homes with support structures in place or onward referral to more appropriate settings (e.g. a nursing home or step-down facility with MDT) when admission to an acute hospital was not required.