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Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical
Helen Anne Snooks1, Ben Carter2, Jeremy Dale3
1Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom.
Objective:
To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.
Design:
Cluster trial randomised by paramedic; modelling.
Setting:
13 ambulance stations in two UK emergency ambulance services.
Participants:
42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.
Interventions:
Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture.
Main Outcome Measures:
Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.
Safety:
Further emergency contacts or death within one month.
Cost-Effectiveness:
Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.
Results:
17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS -0.74, 95% CI -2.83 to +1.28; PCS -0.13, 95% CI -1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without.
Conclusions:
Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.
Trial Registration:
ISRCTN Register ISRCTN10538608.
