Older People’s Assessment and Liaison (OPAL) Team

There are two OPAL services in operation across Lewisham and Greenwich NHS Trust (LGT):

  1. A team based at the Queen Elizabeth Hospital (QEH) Woolwich
  2. A team based at University Hospital Lewisham (UHL).

The OPAL Teams are multidisciplinary and consist of:

  • Consultant Geriatrician
  • OPAL Nurse Specialist
  • OPAL Therapy Specialist
  • Middle Grade Doctor support at Senior Clinical Fellow Level (QEH site)

The OPAL Team at QEH assess people aged 70 or older in the A&E Department, with the focus being on admissions avoidance. The OPAL Team work closely with the A&E staff to encourage referrals at the point of triage, as well as carrying out case finding throughout the day.  The OPAL Team also attend an 08.30 huddle in the A&E department.

The OPAL Team aim to take the pressure off A&E and to assist with the four hourly targets. The OPAL Team take full responsibility for the patient during their stay in A&E and complete the discharge process and all relevant paperwork. All patients seen by the OPAL will have a Comprehensive Geriatric Assessment (CGA) completed.

Those patients that the OPAL Team cannot discharge home on the same day, due to waiting for further diagnostics, care package etc may be required to spend an overnight stay in the Clinical Decisions Unit or be referred to the Frailty Short Stay Unit. The OPAL Team will follow these patients up the following day to facilitate the discharge home.

The OPAL Team at UHL provide an in-reach service to the Acute Medical Unit and the medical wards to ensure that all patients admitted, over the age of 75, receive a Comprehensive Geriatric Assessment (CGA). The team also work closely with the Lewisham Intermediate Care (LINC) Team in A&E to facilitate safe discharges in support of admissions avoidance. A CGA will also be completed as part of this process.

The CGA is multidimensional and covers the following components:

  • Medical
  • Psychological
  • Social
  • Environmental
  • Function
  • Medication

On completion of the CGA an individual management plan is formulated with the patient, carer, family.  This is written in detail on the discharge summary/medical notes.

Information on specific elements of the individual management plan are shared with the relevant professionals: GP, Specialist Nurses, District Nurses, Social Services, Community Mental Health, Community therapies.

The aim of the individual management plan is to reduce further A&E presentations and unnecessary hospital admissions. If the OPAL Team identify concerns at the point of discharge from A&E, they can arrange for the patient to be reviewed by a Consultant Geriatrician in the Rapid Access Clinic (QEH). This review can take place the following day, following week etc, depending on individual need.

The OPAL Teams work closely with the Joint Emergency Team (JET), Bexley Rapid Response Team (BRRT) and LINC Team to facilitate rehabilitation pathways for identified patients to ensure a safe discharge home.

The OPAL Teams carry out follow up telephone calls to those patients that have been discharged from A&E under the admissions avoidance process. The purpose of the follow up telephone calls is to ensure the individual management plan is in place. If the OPAL Team identify concerns during the follow up calls, an appointment can be made for the patient to be reviewed in the Rapid Access Clinic. The patient will be reviewed by the Consultant Geriatrician in the Rapid Access Clinic and specific members of the OPAL Team to review the individual management plan.

Referrals

The OPAL Teams accept referrals through the following routes:

  • From the streaming nurse by the Urgent Care streamer
  • From A&E Triage nurse
  • From A&E by the A&E team of doctors
  • From the Medical take team
  • From the previous day’s take (within 24hrs): patients to be agreed as suitable
  • From GPs
  • From JET, BRRT, LINC

Referral criteria:

Aged over 70 (75yrs at UHL) have a Rockwood Clinical Frailty score of 4>, be physiologically stable AND present with one or more of the following frailty syndromes:

  • Falls
  • Immobility
  • Delirium/Dementia
  • Incontinence
  • Poly-pharmacy
  • Carer strain

Exclusion criteria:

  • Physiologically unstable
  • Critically ill
  • Patient requiring speciality specific protocol

The OPAL Teams aim to see all patients referred within one hour of referral.

The OPAL Teams currently work Monday to Friday 09.00-17.00: the last referral is taken at 16.00. If the OPAL Team are unable to take a referral at 4pm, due to workload, they will inform the referrer and provide advice/signposting as indicated.

How to access the service:

QEH: 0208 836 6000  Bleep 411 (NB. This may change in the near future)

UHL: 0208 333 3000 (No bleep or mobiles available at this time)