Abstract
Background
The Ageing Well programme within the NHS Long Term Plan promotes person-centred care aligning with the goals of Integrated Care Systems (ICSs) in unifying health and social care aiming to increase the proportion of care to older people delivered in the community (NHS England, 2019). As most older people admitted to hospital are conveyed by ambulance services this presents a focus to reduce hospitalisation (Maynou L, Street A, Burton C, et al. Emergency Medicine Journal 2023).
North Central London ICS has invested in ‘Silver Triage’ a pre-hospital telephone support scheme which sees geriatricians and emergency physicians supporting the London Ambulance Service in their clinical decision making relating to older people at the point of assessment.
Methods
Data from the first fourteen months of the scheme was analysed.
Results
Between November 2021 and January 2023 there have been 452 Silver Triage cases with 80% resulting in a decision to not convey an older person to hospital. The mode clinical frailty scale (CFS) score was 6 with no difference in conveyance rates based on CFS. Prior to triage paramedics thought hospitalisation was not needed in 44% of cases (n=72/165). Most paramedics (93%, n=154/165) found it easy to contact the team with all 176 who responded to a post triage survey answering they would use it again. Many (66%, n=108/164) felt they learnt something from the discussion, with 16% (n=27/164) reporting it changed their decision-making process.
Conclusion
Silver Triage has the potential to improve the care of older people by preventing unnecessary hospitalisation and has been well received by paramedics.
Comments
Possibility of harm
How do you know that the Silver Triage service has not caused harm because patients who should have come to hospital did not come to hospital?
We are in the process of data linking with other available data sets to determine this statistically. We have data for people who have repeated silver triage calls over subsequent hours / days and their outcomes. Data is available from the ambulance side for repeated call outs regardless of enrolement into Silver Triage. Triangulating this data will demonstrate risk / benefit but from preliminary data available this has not been shown. We are investigating mortality, admission rates, LOS etc. Thanks
Challenges
Is there any potential challenges for sustainability of implementation of the Silver Triage service?
There is ongoing service evaluation to determine this but resource allocation of Geriatricians is the primary issue of sustainability but more are being recruited / trained across the sector. Thanks
Comment
We run a similar service in collaboration with ambulance service and community partners . This service does provide support and tends to get the right care to our patients at the right time and at the right place. With respect to outcome of all those patients we have consulted the initial data shows readmission or representations to hospitals have been low.