What is the impact of a pre-hospital geriatrician led telephone 'Silver Triage' for older people living with frailty?

Eur Geriatr Med. 2023 Oct;14(5):977-981. doi: 10.1007/s41999-023-00796-9. Epub 2023 May 23.

Abstract

Purpose: Most older people are conveyed to hospital via ambulance, therefore presenting a focus to reduce hospitalisation. North Central London has introduced 'Silver Triage', a pre-hospital telephone support scheme where geriatricians support the London Ambulance Service with clinical decision-making.

Methods: Data from the first 14 months was analysed descriptively.

Results: There have been 452 Silver Triage cases (November 2021 to January 2023). 80% resulted in a decision to not convey. The mode clinical frailty scale (CFS) was 6. CFS did not influence conveyance rates. Prior to triage, paramedics thought hospitalisation was not required in 44% of cases (n = 72/165). All paramedics surveyed (n = 176) would use the service again. Most (66%, n = 108/164) felt they learnt something and 16% (n = 27/164) reported 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.

Keywords: Frailty; Geriatric assessment; Older people; Pre-hospital; Telemedicine.