NHS, technology and OPEL: the systems used in A&E departments

It’s impossible to miss how the NHS is portrayed in the news every year. The term ‘winter crisis’ makes headlines, and A&Es are often put in the spotlight. As the first port of call for emergency care, A&E departments face a difficult challenge. They get the bulk of critical patients – while also dealing with non-critical, trivial or non-emergency cases – plus also bearing the brunt of issues that are prevalent across the NHS. At a very basic level, this includes a lack of staff, funding and resources, but at a wider level, the issues in the NHS are multifaceted.

Introducing ‘Crisis Point: A Day in A&E

Some of those issues are highlighted in a new game created by specialist lawyers Bolt Burdon Kemp. The ‘Crisis Point: A Day in A&E’ game simulates day-to-day life as an A&E staffer. The player undertakes two 12-hour shifts, under the guise of interchanging members of A&E staff.

The mission? To make the right decisions so you maintain a high in-game status level, with Level 0 representing the best score and Level 3 representing the worst performance. Every decision you make affects the status level – choose poorly and you may see your status level steadily dip from green, to yellow, to red and finally black.

While playing, you gain an insight into the numerous patient care, staffing and triage issues that contribute to the problems within the NHS.

What is the OPEL framework?

What’s interesting about the simulation is that the in-game status levels and colour coding is based on an actual framework used by the NHS: the OPEL framework.

The Operational Pressures Escalation Levels (OPEL) Framework was introduced in October 2016 in hospitals across England. It was designed to replace the older system of ‘red’ and ‘black’ alerts and to introduce a centrally-agreed set of definitions and guidelines for NHS Trusts to use to determine if they’re under undue pressure.

Similar to in the game, the NHS uses 4 OPEL levels. Level 1 represents optimal conditions – the patient flow can be maintained well, and the hospital is able to meet anticipated demand without issues. Levels 2 and 3 respectively signify increasing signs of pressure, with the hospital at risk of not being able to meet patient demand. The lowest Level 4 represents a major crisis (the equivalent of the old ‘black’ alerts) and urgent action will need to be taken.

The OPEL system gave clarity to hospitals on three major factors:

  • Better identification of problems, at the cusp of it happening, rather than fighting issues retroactively
  • Clear guidelines to allow a better understanding of the actions that need to be taken to prevent problems worsening
  • Giving an overall picture of how the hospital is performing, including on a national level

For example, in January 2017, the system made it possible to discover that 52 NHS Trusts reported an OPEL 3 and experienced serious pressures that compromised patient flow.

What is the four-hour government target, and why was it ineffective?

Another factor explored by the game is the four-hour A&E waiting time target set by the government. The target stipulates that 95% of patients must be seen, then treated, admitted or discharged within four hours of entering A&E. Each patient is given a colour coded indicator level that steadily shifts depending on how long they have been in the department.

Unfortunately, while the target made a big difference when first introduced in 2003 – waits of over 12 hours were common before the target came into place – it eventually became ineffective. The focus shifted from patient care to staying within target and, ultimately, around a fifth of all patients were admitted in the final 10 minutes before the deadline. It’s no wonder, then, that in 2018, the government scrapped the target until April 2019; it is currently under review with a new system potentially set to replace it.

While some systems have been better for the NHS than others, the use of technology in A&Es should continue to be explored. The potential for tech to monitor patients – beyond their vital signs – can only be realised by critically evaluating the current systems within the NHS. After all, there are plenty of technologies that have the potential to be developed or adapted to help improve patient flow and eventually prevent the ‘winter crisis’ from continuing to be part and parcel of life in A&E.

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