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

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

Authors

Terence J. Quinn

Helen Anne Snooks

Ben Carter

Jeremy Dale

Theresa Foster

Ioan Humphreys

PIP LOGAN pip.logan@nottingham.ac.uk
Professor of Rehabilitation Research

Ronan Anthony Lyons

Suzanne Margaret Mason

Ceri James Phillips

Antonio Sanchez

Mushtaq Wani

Alan Watkins

Bridget Elizabeth Wells

Richard Whitfield

Ian Trevor Russell



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.

Journal Article Type Article
Publication Date Sep 12, 2014
Journal PLoS ONE
Electronic ISSN 1932-6203
Publisher Public Library of Science
Peer Reviewed Peer Reviewed
Volume 9
Issue 9
Article Number e106436
APA6 Citation Quinn, T. J., Snooks, H. A., Carter, B., Dale, J., Foster, T., Humphreys, I., …Russell, I. T. (2014). Support and assessment for Fall Emergency Referrals (SAFER 1): cluster randomised trial of computerised clinical decision support for paramedics. PLoS ONE, 9(9), https://doi.org/10.1371/journal.pone.0106436
DOI https://doi.org/10.1371/journal.pone.0106436
Publisher URL http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106436
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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