Abstract
Background
North Central London Integrated Care System has invested in a pre-hospital programme where geriatricians and emergency physicians support London Ambulance Service via a telephone ‘Silver Triage’ in their clinical decision making on whether to convey an older person living with frailty to hospital. The results of the scheme are described elsewhere.
Methods
452 cases were discussed with Silver Triage between November 2021 and January 2023. Paramedics using the service were sent a survey including a free text question on how the scheme could be improved which was analysed using thematic analysis.
Results
We received 103 comments on how we could improve which fell into three key themes each with subsequent subthemes:
1. Improving access to the service – this included expanding into a 24-hour service, accessible in other areas of London, available to emergency medicine technicians and for people not living in care or nursing homes.
2. Improving information about the service – this included education for paramedics on who to refer but also increasing awareness of the scheme in local emergency departments.
3. Improving delivery of the service – this included requests for video conferencing, reported technology issues and frustrations with pathway breakdown following triage. For example if the agreed plan was not to convey and to support through rapid response or district nurse services, lack of availability led to conveyance to hospital contrary to outcome of triage.
Conclusion
Whilst the Silver Triage scheme has been well received by paramedics there are clear areas for improvement to ensure sustainable and equitable pre-hospital care for older people living with frailty.
Comments
triage tool
did the paramedics have access to a trauma triage tool to lower threshold for suspicion in frail trauma eg mechanism of injury or were they asked to phone for every older patient who had fallen?
Thanks for the question- they had access to their usual triage tools, and called for those they would have otherwise conveyed to hospital according to protocol, or cases they were uncertain about e.g. head injury on anticoagulation.
If you're interested, we have presented quantitative data about the impact on another poster 1595: What is the impact of a pre-hospital geriatrician led telephone ‘silver triage’ for older people living with frailty?