Milan launches “code silver” for elderly patients

New level to traditional triage.

Elderly patients with respiratory or heart diseases or suffering from dementia will now have a fast track available, bypassing the traditional “code red, yellow or green” triaging at Milan’s Fatebenefratelli Pronto Soccorso (A&E) department.

Reception staff triaging patients will take into account their age, recent A&E or other hospital visits, how much help they need to get through the day or take their medication, and whether they are being cared for by municipal or other welfare services. And a geriatrics specialist will be added to the medical team in the emergency room.

Dubbed “code silver”, the new procedure will be available for senior patients needing emergency help, but for whom doctors consider neither hospitalisation nor sending back home to be appropriate.

Instead, they will be transferred to the Pio Albergo Trivulzio, a charity retirement home founded in 1766 with the legacy of Milan aristocrat and philanthropist Tolomeo Trivulzio. Relocated in the past century to a site on the road from the city centre to Baggio suburb, it is better known to milanesi by its familiar nickname of “the Baggina”.

Ten beds there have been converted for use by the elderly and reserved for “code silver” patients.

The service will be available in the experimental start-up phase in two formats: monitoring of symptoms for 48-72 hours, or – in more serious cases – monitoring and stabilisation over 7-10 days.

“This way, Lombardy regional health service is following the path of improved special attention to the fragility of the elderly,” said regional councillor Giulio Gallera, announcing the system, “as well as reducing time spent in A&E departments or inappropriately in hospital wards.”

The new code is also being introduced in Brescia, and will be gradually rolled out to other Lombardy hospitals.