Support and Assessment for Fall Emergency Referrals (SAFER 1): Cluster Randomised Trial of Computerised Clinical Decision Support for Paramedics

Abstract

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.

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