Comparing paramedic and geriatrician Clinical Frailty Scale scores: a baseline evaluation to improve frailty pathway allocation

Introduction

Accurate prehospital frailty scoring allows direct admission to older persons' assessment units (OPAU), enabling early comprehensive geriatric assessment (CGA) and reducing unnecessary hospital admissions. The Welsh Ambulance Service Trust (WAST) uses the Clinical Frailty Scale (CFS) to guide pathway decisions, and patients scoring ≥5 may be eligible for direct OPAU admission. We compared paramedic CFS scores with those derived from in-hospital CGA, and surveyed paramedics about their training needs.

Method

We undertook a single-point data collection across OPAU and acute geriatric medicine wards at one hospital site. Patients aged ≥65 who had arrived by ambulance were identified and their prehospital CFS scores compared with CGA-derived scores using a paired t-test. We also surveyed 20 paramedics about their confidence in assessing frailty and current training provision.

Results

67 patients were included (mean age 83.5 years, SD 7.8). Two-thirds had a documented frailty syndrome. Paramedics recorded a CFS in 44 cases (66%). Where paired scores were available (n=43), CGA scores were significantly higher than paramedic scores (mean 6.16 vs 5.40, difference 0.77, p<0.001). Paramedics underscored in 63% of cases and exact agreement occurred in only 33%. All 20 surveyed paramedics reported using CFS, but 90% wanted more training and 35% felt current teaching was inadequate.

Conclusion

Paramedics scored frailty approximately one point lower than geriatricians, meaning some frail patients may be missing OPAU pathways designed to streamline their care. The survey findings suggest this reflects a training gap rather than lack of engagement. We plan to deliver focused CFS training to WAST staff and re-audit to see if this improves scoring accuracy.