PLoS ONE (Jan 2014)

Support and Assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics.

  • Helen Anne Snooks,
  • Ben Carter,
  • Jeremy Dale,
  • Theresa Foster,
  • Ioan Humphreys,
  • Philippa Anne Logan,
  • Ronan Anthony Lyons,
  • Suzanne Margaret Mason,
  • Ceri James Phillips,
  • Antonio Sanchez,
  • Mushtaq Wani,
  • Alan Watkins,
  • Bridget Elizabeth Wells,
  • Richard Whitfield,
  • Ian Trevor Russell

DOI
https://doi.org/10.1371/journal.pone.0106436
Journal volume & issue
Vol. 9, no. 9
p. e106436

Abstract

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ObjectiveTo evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.DesignCluster trial randomised by paramedic; modelling.Setting13 ambulance stations in two UK emergency ambulance services.Participants42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.InterventionsIntervention 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 measuresEffectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.SafetyFurther emergency contacts or death within one month.Cost-effectivenessCosts and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.Results17 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.ConclusionsIntervention 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 registrationISRCTN Register ISRCTN10538608.