Posted on: 20 July 2023
Many older people living with frailty are taken to hospital by ambulance but then turn out not to need hospital care. The Silver Triage initiative in North Central London aims to make sure more older people living with frailty get urgent care in their home setting.
The initiative enables specialist geriatricians to provide advice to ambulance paramedics.
Key benefits and outcomes
- Substantial reduction in patients taken to hospital, from 75% in 2018 down to 20% in 2023
- 100% of paramedics would use the system again
- The scheme has been extended to cover people living in their own homes who make up a majority of those seen
What we faced
Like many other areas, North Central London (NCL) saw a disproportionate number of emergency hospital admissions from people living with frailty aged over 75 – especially those with dementia.
Many 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 can be particularly distressing to those with dementia.
What we did
In 2022 we set up a scheme called Silver Triage, bringing together LAS and NHS trusts.
The ambulance service accesses the scheme though a single phone number. The paramedics explain the situation, the patient’s background, their initial assessment, and recommended plan.
Specialist geriatricians provide guidance to ambulance paramedics and help coordinate community services to provide care at home.
Overcoming obstacles
There have been several challenges to setting up the scheme.
The first is a shortage of consultants to cover the telephone. This means it hasn’t been possible (yet) to extend the hours beyond 9am to 5pm each day.
Governance was one of the major challenges. It was decided that only paramedics would be able to access the system, not other unregistered ambulance staff.
Deciding where the clinical responsibility for the service would sit was also important, and it was agreed this would sit with CNWL as the provider lead.
Takeaway tips
- The service may need to be tailor-made to different locations to reflect what local services are available and what gaps there are.
- Paramedics and consultants need to understand each other’s role, skills, and knowledge to build trust.
- The system must be easy to use: NCL used Consultant Connect to ensure that calls were answered promptly.
For more information, contact Rebecca Dunkerley, Head of Camden Integrated Adult Services at CNWL: rebecca.dunkerley@nhs.net