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Support and Assessment for Fall Emergencies (SAFE) Trial

Support and Assessment for Fall Emergencies (SAFE) Trial. An evaluation of the costs and benefits of computerised on-scene decision support for emergency ambulance personnel to assess and plan appropriate care for older people who have fallen. Background

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Support and Assessment for Fall Emergencies (SAFE) Trial

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  1. Support and Assessment for Fall Emergencies (SAFE) Trial An evaluation of the costs and benefits of computerised on-scene decision support for emergency ambulance personnel to assess and plan appropriate care for older people who have fallen

  2. Background • Falls in older people account for a significant proportion of 999 calls in the UK (London: 8%) • Many of these patients are left at scene (London: 29 – 52%) • Older people who fall have a high risk of: • falling again • Injury • Disability / loss of independence • Death • A falls service intervention delivered from A&E has been shown to be effective (Close et al, Lancet 1999;353(9147):93-7) • The 999 group are older and frailer: can a similar intervention triggered by paramedics on-scene work? • Funded through the Department of Health Policy Research Programme focused on IT and chronic disease management (£413,000) supplemented by the Clinical Research Collaboration – Cymru (£100,000)

  3. Study aim: To assess costs and benefits of hand-held CDS technology for the on-scene assessment and care of older people who fall and call 999 Objectives: To compare between intervention and control group patients at one month and six months • number of further falls for which a 999 call is made • number of A&E attendances and hospital admissions • quality of life, independence and satisfaction of patients and carers • operational ‘process’ indicators: on-scene times, job cycle times • impact on resource utilisation within the NHS and costs to patients and their families

  4. Research Methods • Cluster RCT: 20 paramedics per service randomly allocated to intervention or control group • 4 days additional training plus hardware and software to support assessment of patients for ‘intervention paramedics’ • Comparison of processes and outcomes of care of patients attended by ‘intervention paramedics’ with those of patients attended by ‘control crews’ delivering usual care • Qualitative in-depth follow-up of a sample of older people who have fallen • focus groups with crews before and after implementation • other individual or group interviews to capture the views of other stakeholders concerning implementation issues

  5. Progress so far… • Study 30 months: August 1 2006 – January 31 2009 • 3 participating ambulance services: • Wales (Swansea) • West Midlands (Coventry) • East Midlands (Lincolnshire) • 3 research officers • (Swansea: 2; Warwick 1) • New developments • Ambulance service reorganisation • Connecting for Health roll out of electronic patient report form across England • Potential to strengthen study • Study extension agreed with DH to allow integration of programmes

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