Snooks, Helen, Carter, Ben, Dale, Jeremy, Foster, Theresa, Humphreys, Ioan, Logan, Philippa Anne, Lyons, Ronan, Mason, Suzanne Margaret, Phillips, Ceri James, Sanchez, Antonio, Wani, Mushtaq, Watkins, Alan, Wells, Bridget Elizabeth, Whitfield, Richard and Russell, Ian Trevor (2014) Support and assessment for fall emergency referrals (SAFER 1) : cluster randomised trial of computerised clinical decision support for paramedics. PLoS One, Volume 9 (Number 9). Article number e106436. doi:10.1371/journal.pone.0106436 ISSN 1932-6203.
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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.
| Item Type: | Journal Article |
|---|---|
| Subjects: | R Medicine > RA Public aspects of medicine |
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Social Science & Systems in Health (SSSH) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
| Library of Congress Subject Headings (LCSH): | Emergency medical technicians, Decision making |
| Journal or Publication Title: | PLoS One |
| Publisher: | Public Library of Science |
| ISSN: | 1932-6203 |
| Official Date: | 12 September 2014 |
| Dates: | Date Event 12 September 2014 Published 5 August 2014 Accepted 27 March 2014 Submitted |
| Volume: | Volume 9 |
| Number: | Number 9 |
| Article Number: | Article number e106436 |
| DOI: | 10.1371/journal.pone.0106436 |
| Status: | Peer Reviewed |
| Publication Status: | Published |
| Access rights to Published version: | Open Access (Creative Commons open licence) |
| Date of first compliant deposit: | 27 March 2016 |
| Date of first compliant Open Access: | 27 March 2016 |
| Funder: | Great Britain. Department of Health (DoH) |
| Grant number: | 0200055 (DoH) |
| URI: | https://wrap.warwick.ac.uk/63277/ |
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