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

Abstract

BackgroundMany 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/DesignPragmatic 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.DiscussionSince 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.Trial RegistrationISRCTN10538608

Alternatives to Traditional EMS Dispatch and Transport: A Scoping Review of Reported Outcomes

“…The majority of study designs were those without a comparison group (n = 14), followed by studies with a retrospective comparison group (n = 6). There were • Event-free period 66 • Quality of life 59,66,67 • Quality-adjusted life years 67 • Diagnosis/chief complaint 45,46,56 Outcome Safety…”

“…• EMS response intervals 12,25 • EMS job cycle time 17,24,25,66 • EMS time on scene 46,66 • Episode of care time 66 • Time to contact with definitive care (ED or primary care) 43,66 • Time to ED triage 56 • Length of hospital stay 66 • Time from call to discharge 59 • Choose time points in which data entry for these fields by dispatch, EMS clinicians or hospital staff is mandatory, to minimize missing data.…”

“…Report each time point and interval clearly. • 911 calls directed to alternative 14,22,26,65,66 • Clearly define study patients, e.g., number of calls referred/total eligible calls. 22,26 • Calls returned from alternative (e.g., nurse advice line) back to EMS dispatch 16,25 • Consensus required on what a "successful" referral is, e.g., calls that are referred and referral agency does not return call back to 911.…”

“…29 • Number of nontransports 14,17,24,29,43,45,46,50,52,66 • A non-transport may be defined as paramedics not transporting the patient from scene. There could be various reasons.…”

“…• Effect on EMS system performance measures 66,67 • Consensus on which system performance measures are most important, e.g., emergency call response time.…”