Key result
The pre-hospital geriatrician-led telephone 'Silver Triage' resulted in an 80% non-conveyance rate to hospital for older adults living with frailty.
Why the study?
Most older people are conveyed to hospital via ambulance, presenting an opportunity to reduce hospitalisation.
Does a pre-hospital geriatrician-led telephone triage reduce hospital conveyance in older people living with frailty?
Observational (n=406)
Does a pre-hospital geriatrician-led telephone triage reduce hospital conveyance in older people living with frailty?
A pre-hospital geriatrician-led telephone triage service has the potential to reduce unnecessary hospital conveyances for older people living with frailty and is well received by paramedics.
Geriatrician-led triage may reduce conveyance in frail older adults; extends observational models but leaves open safety and outcomes in RCTs.
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.
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Jones et al. (2023) conducted an observational in Frailty in older adults (n=406). Silver Triage (pre-hospital geriatrician-led telephone support) was evaluated on Decision to not convey to hospital (95% CI 76-84). The pre-hospital geriatrician-led telephone 'Silver Triage' resulted in an 80% non-conveyance rate to hospital for older adults living with frailty.
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