Green Jonathan, Kirby Kim, Hope Suzy
South Western Ambulance Service NHS Foundation Trust: Orcid ID: 0000-0001-5738-7515.
University of the West of England; South Western Ambulance Service NHS Foundation Trust: Orcid ID: 0000-0002-8092-7978.
Br Paramed J. 2018 Dec 1;3(3):23-33. doi: 10.29045/14784726.2018.12.3.3.23.
More than half of all patients attended by the South Western Ambulance Service NHS Foundation Trust are over the age of 65. In 2017, 62% of older patients who were the subject of a frailty assessment were believed to have at least mild frailty (1/5 of all patients). 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.
To explore and gain insight into the current knowledge, practice and attitudes of ambulance clinicians regarding frailty and patients with frailty.
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.
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.
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.
西南救护车服务国民保健服务信托基金接待的患者中，超过半数年龄在65岁以上。2017年，接受衰弱评估的老年患者中有62%被认为至少存在轻度衰弱（占所有患者的五分之一）。衰弱是一个越来越重要的概念/诊断，救护车服务机构处于识别衰弱并影响患者就医“护理路径”（从而影响健康结果）的有利位置。2017年，西南救护车服务国民保健服务信托基金为临床人员举办了一次关于衰弱的强制性培训课程，并且在电子患者临床记录中提供了衰弱评估工具。
探讨并深入了解救护车临床医生对衰弱及衰弱患者的现有知识、实践和态度。
2017年10月，从西南救护车服务国民保健服务信托基金招募了两组救护临床医生焦点小组（一组8人，另一组9人）。对焦点小组讨论进行了主题分析。
焦点小组参与者对衰弱概念模型、衰弱患者的适当评估和适当护理路径的了解差异很大。为相关患者填写“罗克伍德”临床衰弱量表已成为常规操作。然而，对于其填写背景和目的存在相互矛盾的观点。“起立行走计时”活动能力评估工具也在电子患者临床记录中，但在填写方面存在困难。患者管理策略包括救护车服务可提供的治疗选项、转介至可支持患者居家管理的初级/社区护理，以及直接将患者转介至医院科室或专家以促进适当评估、治疗和出院的选项。讨论的一个主要特点是对这些转介路径的可用性有限和地域差异的看法，这引发了关于意识、能力、跨专业关系和患者选择的问题。
救护人员在衰弱方面的知识、实践和态度差异很大。这反映了该病症在救护车行业和更广泛的医疗保健系统中，在学术和临床方面的新兴性质。
