title: 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.
  
  
  METHODS
  Cluster trial randomised by paramedic; modelling.
  
  
  METHODS
  13 ambulance stations in two UK emergency ambulance services.
  
  
  METHODS
  42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.
  
  
  METHODS
  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.
  
  
  METHODS
  Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.
  
  
  RESULTS
  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.
  
  
  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.
  
  
  BACKGROUND
  ISRCTN Register ISRCTN10538608.
authors.affiliation: Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Helen Anne
authors.initials: HA
authors.lastname: Snooks
authors.affiliation: Institute of Primary Care & Public Health, Cardiff University School of Medicine, Neuadd Meirionnydd, Heath Park, Cardiff, United Kingdom.
authors.forename: Ben
authors.initials: B
authors.lastname: Carter
authors.affiliation: Warwick Medical School, Gibbet Hill Campus, University of Warwick, Coventry, United Kingdom.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Dale
authors.affiliation: East of England Ambulance Service NHS Trust, Milford Service Area, Fiveways Roundabout, Barton Mills, Suffolk, United Kingdom.
authors.forename: Theresa
authors.initials: T
authors.lastname: Foster
authors.affiliation: Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Ioan
authors.initials: I
authors.lastname: Humphreys
authors.affiliation: Division of Rehabilitation and Ageing, School of Community Health Sciences, University of Nottingham, Nottingham, United Kingdom.
authors.forename: Philippa Anne
authors.initials: PA
authors.lastname: Logan
authors.affiliation: Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Ronan Anthony
authors.initials: RA
authors.lastname: Lyons
authors.affiliation: School of Health and Related Research, Sheffield University, Regent Court, Sheffield, United Kingdom.
authors.forename: Suzanne Margaret
authors.initials: SM
authors.lastname: Mason
authors.affiliation: Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Ceri James
authors.initials: CJ
authors.lastname: Phillips
authors.affiliation: Department of Medicine, Cardiff University, Academic Building, Llandough Hospital, Penarth, United Kingdom.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sanchez
authors.affiliation: Abertawe Bro Morgannwg University Health Board, Department of Stroke Medicine, Morriston Hospital, Morriston, Swansea, United Kingdom.
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Wani
authors.affiliation: Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Watkins
authors.affiliation: Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Bridget Elizabeth
authors.initials: BE
authors.lastname: Wells
authors.affiliation: Prehospital Emergency Research Unit, Welsh Ambulance Services NHS Trust, Lansdowne Hospital, Canton, Cardiff, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Whitfield
authors.affiliation: Institute of Life Science, College of Medicine, Swansea University, Singleton Park, Swansea, United Kingdom.
authors.forename: Ian Trevor
authors.initials: IT
authors.lastname: Russell
mesh_terms: D000058:Accidental Falls / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D016000:Cluster Analysis; D020000:Decision Support Systems, Clinical / Q000191:economics*; D004630:Emergencies; D005260:Female; D017048:Health Care Costs; D006801:Humans; D033181:Information Dissemination; D008297:Male; D012017:Referral and Consultation / Q000191:economics*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome