Paramedics’ experiences of using the clinical frailty scale in prehospital care: a qualitative study

Background The demographic shift toward an ageing population has increased focus on frailty. Frailty has become increasingly recognized as a critical factor in clinical decision-making and the Clinical Frailty Scale (CFS) has gained widespread use across healthcare settings. This study explores paramedics’ experiences using CFS for older patients. Methods This study uses a qualitative research design and incorporates semi-structured interviews to explore paramedics’ experience of the feasibility and practical application of CFS in prehospital care. The study is part of a larger project on the use of CFS for older patients (≥ 65 years) in prehospital care in the North Denmark Region. During the study period 432 of 2 084 patients (21%) had a documented CFS score. CFS scores spanned all nine categories of the scale. The study is inspired from hermeneutic philosophy and frailty assessment theory. Individual face-to-face semi-structured interviews were conducted, and data was analysed using thematic analysis, inspired by Braun and Clarke’s six-phase framework. Results A total of eleven paramedics participated in the interviews (ten men and one woman). The median age was 38 years, and participants had a median of 11 years of experience in the prehospital setting. Three main themes emerged: (1) Older patients – complexity and clinical assessment (2) Making CFS work in the prehospital practice (3) CFS as a shared language in cross-sector collaboration. Older patients were perceived as a complex and habitually ill population requiring an adapted clinical mindset. Distinction between acute illness and frailty was described as challenging in the prehospital setting. CFS was considered to serve as a bridge between sectors and professional discipline. Conclusion CFS was generally perceived as relevant and as a tool that can support continuity of care and create a shared language around frailty. The findings highlight the importance of paramedics understanding the purpose and application of CFS and how the assessment may contribute to patient care across sectors. These considerations may be relevant when supporting the use of CFS in routine prehospital practice. Clinical trial number Not applicable.