W Teranaka, H T Jones, B Wan, A Tsui, L Gross, P Hunter, S Conroy

1596 HOW COULD PRE-HOSPITAL ‘SILVER TRIAGE’ FOR OLDER PEOPLE LIVING WITH FRAILTY BE IMPROVED? – THE VIEWS OF PARAMEDICS

  • Geriatrics and Gerontology
  • Aging
  • General Medicine
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Abstract Background Most older people access acute hospital care via ambulance conveyance. The ambulance service provides a key link in the urgent care chain, yet the role of frailty-attuned assessment and care in this context is poorly understood. North Central London Integrated Care System has invested in a pre-hospital programme where geriatricians and emergency physicians support London Ambulance Service: ‘Silver Triage’. We report here on feedback on the scheme from paramedics. Methods 452 cases were discussed with Silver Triage between November 2021 and January 2023. Paramedics using the service were sent a survey including a free text question on how the scheme could be improved which was analysed thematically. Results 103 comments were organised into three key themes: 1. Improving access to the service – this included expanding to a 24-hour service, accessible in other areas of London, available to emergency medicine technicians and for people not living in care homes. 2. Improving information about the service – this included education for paramedics on who to refer but also increasing awareness of the scheme in local emergency departments. 3. Improving delivery of the service – this included requests for video conferencing, reported technology issues and frustrations with pathway breakdown following triage. For example, if the agreed plan was not to convey and to support through rapid response or district nurse services, lack of availability led to conveyance to hospital contrary to outcome of triage. Conclusion Whilst the Silver Triage scheme has been well received by paramedics, there are clear areas for improvement to ensure sustainable and equitable pre-hospital care for older people living with frailty.

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