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Ambulance clinicians’ perceptions,assessment and management of frailty: Thematic analysis of focus groups

Green, Jonathan; Kirby, Kim; Hope, Suzy


Jonathan Green

Kim Kirby

Suzy Hope


Frailty is an increasingly relevant concept/diagnosis and ambulance services are well positioned to identify frailty and influence the ‘care pathways’ through which patients are directed (thereby influencing health outcomes. Throughout the South Western Ambulance Service NHS Foundation Trust, a mandatory training session regarding frailty was delivered to clinical personnel in 2017 and frailty assessment tools are available on the electronic Patient Clinical Record.

Aim: To explore and gain insight into the current knowledge, practice and attitudes of ambulance
clinicians regarding frailty and patients with frailty.

Methods: Two focus groups of ambulance clinicians (n = 8; n = 9) recruited from across the South Western Ambulance Service NHS Foundation Trust were held in October 2017. Focus group discussions were analysed thematically.

Results: Knowledge of conceptual models of frailty, appropriate assessment of patients with frailty and appropriate care pathways varied substantially among focus group participants. Completion of the ‘Rockwood’ Clinical Frailty Scale for relevant patients has become routine. However, conflicting opinions were expressed regarding the context and purpose of this. The Timed-Up-and-Go mobility assessment tool is also on the electronic Patient Clinical Record, but difficulties regarding its completion were expressed.

Patient management strategies ranged from treatment options which the ambulance service can provide, to referrals to primary/community care which can support the management of patients in their homes, and options to refer patients directly to hospital units or specialists with the aim of facilitating appropriate assessment, treatment and discharge. Perceptions of limited availability and geographical variability regarding these referral pathways was a major feature of the discussions, raising questions regarding awareness, capacity, inter-professional relationships and patient choice.

Conclusion: Knowledge, practice and attitudes of ambulance staff, with regard to frailty, varied widely. This reflected the emerging nature of the condition, both academically and clinically,within the ambulance profession and the wider healthcare system.


Green, J., Kirby, K., & Hope, S. (in press). Ambulance clinicians’ perceptions,assessment and management of frailty: Thematic analysis of focus groups. British Paramedic Journal, 3(3), 23-33.

Journal Article Type Article
Acceptance Date Dec 1, 2018
Online Publication Date Dec 1, 2018
Deposit Date Feb 12, 2019
Publicly Available Date Feb 12, 2019
Journal British Paramedic Journal
Print ISSN 1478-4726
Publisher The College of Paramedics
Peer Reviewed Peer Reviewed
Volume 3
Issue 3
Pages 23-33
Keywords emergency medical services, frailty, referral and consultation
Public URL
Publisher URL
Additional Information Additional Information : This is the author's accepted manuscript. The final published version is available here:


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