Many older people living with frailty are taken to hospital by ambulance but do not need hospital care. The Silver Triage initiative in North Central London aims to ensure more older people living with frailty receive urgent care in their home setting if this is safe and in keeping with their wishes and preferences.
Like many other areas, North Central London saw a disproportionate number of emergency hospital admissions from people with frailty over 75 – especially those with dementia. Many people in this group, and their carers, would prefer to avoid being taken to hospital but ambulance crews often felt they had little choice, especially when patients had several pre-existing conditions, and they did not have a full oversight of their medical history.
Once at Emergency Departments, patients could face an extended wait for treatment and admission. Admission could lead to hospital-associated disability and be particularly distressing to those with dementia.
To tackle this, in 2022 the North Central London Integrated Care Board approved an initiative to set up a scheme called Silver Triage, bringing together London Ambulance Service and NHS trusts. Silver Triage enables specialist doctors (geriatricians) to advise and guide ambulance paramedics in assessing older people living in care homes. The doctors can also help access and coordinate community services to provide care at home if the person does not need to go to the hospital.
The ambulance service accesses the scheme through a single phone number. Paramedics explain the situation, the patient’s background, their initial assessment, and recommended plan. The specialist doctor can then add to this if they feel it would be appropriate and support the ambulance teams with helping make sure the plan is put into action – for example, by liaising with teams of healthcare staff in the community to make sure they are happy to be involved.
Results and benefits
As a result of the Silver Triage service, there has been a significant reduction in patients in this group being taken to hospital by ambulance – it is now around 20% compared to 75% in 2018.
The scheme began with care homes and, due to its success, has been extended to cover people living in their own homes who now make up a majority of those seen.
Silver Triage is supported by paramedics – 100% said they would use it again.
For more information, please contact: Rebecca Dunkerley, Head of Camden Integrated Adult Services, CNWL, rebecca.dunkerley@nhs.net