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

PLoS One. 2014 Sep 12;9(9):e106436. doi: 10.1371/journal.pone.0106436. eCollection 2014.


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.

Trial registration: ISRCTN Register ISRCTN10538608.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / economics*
  • Aged
  • Aged, 80 and over
  • Allied Health Personnel*
  • Cluster Analysis
  • Decision Support Systems, Clinical / economics*
  • Emergencies*
  • Female
  • Health Care Costs
  • Humans
  • Information Dissemination
  • Male
  • Referral and Consultation / economics*
  • Surveys and Questionnaires
  • Treatment Outcome

Associated data

  • ISRCTN/ISRCTN10538608