Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial
Snooks, Helen, Cheung, Wai-Yee, Close, Jacqueline, Dale, Jeremy, Gaze, Sarah, Humphreys, Ioan, Lyons, Ronan, Mason, Suzanne, Merali, Yasmin, Peconi, Julie, Phillips, Ceri, Phillips, Judith, Roberts, Stephen E., Russell, Ian T., Sánchez, Antonio, Wani, Mushtaq, Wells, Bridget and Whitfield, Richard. (2010) Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial. BMC Emergency Medicine, Vol.10 (No.2). ISSN 1471-227X
WRAP_Dale_Support_Assessment.pdf - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader
Official URL: http://dx.doi.org/10.1186/1471-227X-10-2
Background: Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS) software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services.
Methods/Design: Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial.
Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders.
The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically.
Discussion: Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services.
In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost effectiveness of CCDS for paramedics in the care of older people who have fallen.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RA Public aspects of medicine|
|Divisions:||Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Social Sciences > Warwick Business School > Information Systems & Management
Faculty of Social Sciences > Warwick Business School
Faculty of Medicine > Warwick Medical School
|Library of Congress Subject Headings (LCSH):||Emergency medical services -- Utilization -- Great Britain, Falls (Accidents) in old age -- Great Britain, Older people -- Wounds and injuries -- Great Britain, Older people -- Medical care -- Great Britain|
|Journal or Publication Title:||BMC Emergency Medicine|
|Publisher:||BioMed Central Ltd.|
|Official Date:||26 January 2010|
|Access rights to Published version:||Open Access|
|Funder:||Great Britain. Dept. of Health (DoH), Wales Office of Research and Development for Health and Social Care (WORDHSC)|
1. Bergeron E, Clement J, Lavoie A, Ratte S, Bamvita JM, Aumont F, Clas D: A
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