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• 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)

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

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

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