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

• Published in: PloS one 2014-09, Vol.9 (9), p.e106436-e106436
• Main Authors: Snooks, Helen Anne, Carter, Ben, Dale, Jeremy, Foster, Theresa, Humphreys, Ioan, Logan, Philippa Anne, Lyons, Ronan Anthony, Mason, Suzanne Margaret, Phillips, Ceri James, Sanchez, Antonio, Wani, Mushtaq, Watkins, Alan, Wells, Bridget Elizabeth, Whitfield, Richard, Russell, Ian Trevor
• Format: Article
• Language: English
• Subjects: Accidental Falls - economics; Aged; Aged, 80 and over; Allied Health Personnel; Ambulance services; Clinical decision making; Cluster Analysis; Clusters; Computer simulation; Computers; Cost analysis; Cycle time; Data capture; Decision making; Decision Support Systems, Clinical - economics; Electronic health records; Emergencies; Emergency medical care; Emergency vehicles; Ethics; Falls; Female; Health Care Costs; Health economics; Health sciences; Hospitals; Humans; Information Dissemination; Intervention; Life sciences; Male; Medicine; Medicine and Health Sciences; Modelling; Older people; Paramedics; Patients; Quality of life; Randomization; Referral and Consultation - economics; Safety; Social Sciences; Studies; Surveys and Questionnaires; Tablet computers; Treatment Outcome
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0106436

To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall. Cluster trial randomised by paramedic; modelling. 13 ambulance stations in two UK emergency ambulance services. 42 of 409 eligible paramedics, who attended 779 older patients for a reported fall. 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. Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care. Further emergency contacts or death within one month. Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness. 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. 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. ISRCTN Register ISRCTN10538608.