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 pragmati
详细信息 查看全文
- 作者：Helen Snooks (1)
Wai-Yee Cheung (1)
Jacqueline Close (2)
Jeremy Dale (3)
Sarah Gaze (1)
Ioan Humphreys (6)
Ronan Lyons (1)
Suzanne Mason (4)
Yasmin Merali (5)
Julie Peconi (1)
Ceri Phillips (6)
Judith Phillips (7)
Stephen Roberts (1)
Ian Russell (1)
Antonio Sánchez (1)
Mushtaq Wani (8)
Bridget Wells (1)
Richard Whitfield (9) - 刊名：BMC Emergency Medicine
- 出版年：2010
- 出版时间：December 2010
- 年：2010
- 卷：10
- 期：1
- 全文大小：635KB
- 参考文献：1. Bergeron E, Clement J, Lavoie A, Ratte S, Bamvita JM, Aumont F, Clas D: A simple fall in the elderly: not so simple. / Journal of Trauma-Injury Infection & Critical Care 2006, 60:268-3. CrossRef
2. Sikron F, Giveon A, Aharmson-Daniel L, Peleg K: My home is my castle! Or is it? Hospitalizations following home injury in Israel,1997-001. / Israel Medical Association Journal 2004, 6:332-5.
3. Keene GS, Parker MJ, Pryor GA: Mortality and morbidity after hip fractures. / BMJ 1993, 307.
4. Kellogg International Work Group: The prevention of falls in later life. KIWG on the Prevention of Falls by the Elderly. / Dan Med Bull 1987, 4:1-4.
5. Tinetti ME: Factors associated with serious injury during falls by ambulatory nursing home residents. / J AmGeriatr Soc 1987, 35:644-8.
6. Scuffham P, Chaplin S, Legood R: Incidence and costs of unintentional falls in older people in the United Kingdom. / J Epidemiol 2003, 57:740-4.
7. Department of Health: / National Service Framework for older people. Department of Health; 2001.
8. Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH: / The Cochrane Library: Interventions for preventing falls in elderly people (Cochrane Review). Chichester: John Wiley and Sons Ltd; 2003.
9. Carr AJ, Higginson IJ: Measuring quality of life. Are quality of life measures patient centred? / BMJ 2001, 322:1357-0. CrossRef
10. Graham HJ, Firth J: Home accidents in older people: role of primary health care team. / BMJ 1992, 305:30-2. CrossRef
11. Close JCT: Interdisciplinary practice in the prevention of falls - a review of working models of care. / Age Ageing 2001, 30:8-2. CrossRef
12. American Geriatrics Society. BGSaAAoOS: Guidelines for the prevention of falls in older persons. / J Am Geriatr Soc 2001, 49:664-2. CrossRef
13. Aoyagi K, Ross PD, David JW, Wasnich RD, Hayashi T, Takemoto T: Falls among community-dwelling elderly in Japan. / J Bone Min Res 1998, 13:1468-4. CrossRef
14. National Institute for Clinical Excellence: / Assessment and prevention of falls in older people. National Institute for Clinical Excellence; 2004.
15. Snooks H, Halter M, Close J, Cheung WY, Moore F, Roberts S: Emergency care of older people who fall: a missed opportunity. / Qual Saf Health Care 2006, 15:390-2. CrossRef
16. Weiss SJ, Chong R, Ong M, Ernst AA, Balash M: Emergency medical services screening of elderly falls in the home. / Prehospital Emergency Care 2003, 7:79-4. CrossRef
17. Marks PJ, Daniel TD, Afolabi O, Spiers G, Nguyen-Van-Tam JS: Emergency (999) calls to the ambulance service that do not result in the patient being transported to hospital: an epidemiological study. / Emerg Med J 2002, 19:449-2. CrossRef
18. Snooks H, Porter A, Gaze S, Youren A, Rapport F, Woollard M: / Non-conveyance of 999 patients and related clinical documentation: Policy, practice and views. Report to the Welsh Ambulance Services NHS Trust; 2004.
19. Close JC, Halter M, Elrick A, Brain G, Swift CG: Falls in the older population: a pilot study to assess those attended by London ambulance service but not taken to ED. / Age Ageing 2002, 31:488-9. CrossRef
20. Goldberg RJ, Zautcke JL, Koenigsberg MD, Lee RW, Nagorka FW, Kling M: A review of prehospital care litigation in a larger metropolitan EMS system. / Ann Emerg Med 1990, 19:557-1. CrossRef
21. Cone DC, Kim DT, Davidson SJ: atient-initiated refusals of prehospital care: ambulance call report documentation, patient outcome and on-line medical command. / Prehospital and Disaster Medicine 1995, 10:P22-8.
22. Porter A, Snooks H, Whitfield R, Youren A, Gaze S, Rapport F, Woollard M: Should I stay or should I go? Deciding whether to go to hospital after a 999 call. / J Health Serv Res Policy 2007,12(Suppl 1):32-. CrossRef
23. Porter A, Snooks H, Whitfield R, Youren A, Gaze S, Rapport F, Woollard M: Covering our backs: ambulance crews' attitudes towards clinical documentation when 999 patients are not conveyed to hospital. / Emerg Med J 2008, 5:292-. CrossRef
24. Snooks H, Kearsley N, Dale J, Halter M, Redhead J, Foster T: Gaps between policy, protocols and practice: a qualitative study of the views and practice of emergency ambulance staff concerning the care of patients with non-urgent needs. / Qual Saf Healthcare 2005, 14:251-7. CrossRef
25. Tversky A, Kahneman D: Judgment under uncertainty: heuristics and biases. / Science 1974, 185:1124-1. CrossRef
26. Gates S, Fisher J, Cooke M, Carter YH, Lamb SE: Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis. / BMJ 2008, 336:130-3. CrossRef
27. MRC: / Cluster randomised trials: Methodological and ethical considerations. Medical Research Council; 2002.
28. MRC: / A framework for development and evaluation of RCTs for complex interventions to improve health. Medical Research Council; 2000.
29. Dale J, Williams S, Foster T, Higgins J, Snooks H, Crouch R, Hartley-Sharpe C, Glucksman E: Safety of telephone consultation for 'non-serious' emergency ambulance service patients. / Qual Saf Health Care 2004, 5:363-3. CrossRef
30. Skelton DA, Becker C, Lamb SE, Close JCT, Zijlstra W, Yardley L, Todd CJ: Prevention of Falls Network Europe: a thematic network aimed at introducing good practice in effective falls prevention across Europe. / Eur J Ageing 2004, 1:89-4. CrossRef
31. Ware J, Kosinski M, Keller S: A 1 Item Short-form Health Survey: Construction of scales and preliminary tests of reliability and validity. / Medical Care 1996, 34:220-3. CrossRef
32. Lamb S, Jorstad-Stein EC, Hauer K, Becker C: Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus. / J Am Geriatr Soc 2005, 53:1618-2. CrossRef
33. Carey RC, Seibert JH: A patient survey system to measure quality improvement questionnaire reliability and validity. / Medical Care 1993,31(9):834-5. CrossRef
34. Peconi J, Snooks H, Edwards A: Thematic Research network for emergency and UnScheduled Treatment (TRUST): scoping the potential. / BMC Emerg Med 2008, 8:2. CrossRef
35. Chase D, Roderick P, Cooper K, Davies R, Quinn T, Raftery J: Using simulation to estimate the cost effectiveness of improving ambulance and thrombolysis response times after myocardial infarction. / Emerg Med J 2006, 23:67-2. CrossRef
36. Widiatmoko D, Machen I, Dickinson A, Williams J, Kendall S: Developing a new response to non-urgent emergency calls: evaluation of a nurse and paramedic partnership intervention. / Primary Health Care Research & Development 2008, 9:183-0. CrossRef
37. Snooks H, Williams S, Crouch R, Foster T, Hartley-Sharpe C, Dale J: NHS emergency response to 999 calls: alternatives for cases that are neither life-threatening nor serious. / BMJ 2002, 325:330-3. CrossRef
38. Walker A, Sirel JM, Marsden AK, Cobbe SM, Pell JP: ost effectiveness and cost utility model of public place defibrillators in improving survival after prehospital cardiopulmonary arrest. / BMJ 2003, 327:C1316-9. CrossRef
39. Nichol G, Laupacis A, Stiell I, O'Rourke K, Anis A, Bolley , Detsky AS: Cost-Effectiveness Analysis of Potential Improvements to Emergency Medical Services for Victims of Out-of-Hospital Cardiac Arrest. / Ann Emerg Med 1996, 27:711-0. CrossRef
40. Dowie R, Gregory R, Rowsell K, Annis S, Gick AD, Harrison CJ: A decision analytic approach to commissioning ambulance cardiac services. / J Manag Med 1998, 12:81-1. CrossRef
41. Halter M, Close JCT, Snooks H, Porsz S, Cheung WY: / Fit to be left: can ambulance staff use an assessment tool to decide if an older person who has fallen can be safely left at home?. London, Ambulance Service NHS Trust; 2005.
42. Snooks H, Close J, Gaze S, Halter M, Lyons L, Lervy B, McCabe M, Watkins A, Woollard M, Wani M, Youren A: / Older Fallers Attended by the Ambulance Service and Left at Home: Risks and Opportunities. Swansea: Report to the Wales Office of Research and Development; 2004.
43. The Euroqol Group: EuroQol - a new facility for the measurement of health related quality of life. / Health Policy 1990, 16:199-08. CrossRef
44. Cross M: Will Connecting for Health deliver its promises? / BMJ 2006, 332:599-01. CrossRef
45. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-227X/10/2/prepub - 作者单位：Helen Snooks (1)
Wai-Yee Cheung (1)
Jacqueline Close (2)
Jeremy Dale (3)
Sarah Gaze (1)
Ioan Humphreys (6)
Ronan Lyons (1)
Suzanne Mason (4)
Yasmin Merali (5)
Julie Peconi (1)
Ceri Phillips (6)
Judith Phillips (7)
Stephen Roberts (1)
Ian Russell (1)
Antonio Sánchez (1)
Mushtaq Wani (8)
Bridget Wells (1)
Richard Whitfield (9)
1. Centre for Health Information Research and Evaluation, Swansea University, Swansea, UK
2. Department of Geriatric Medicine at Prince of Wales Hospital, Sydney, Australia
3. Warwick Medical School, University of Warwick, Coventry, UK
6. Institute for Health Research, School of Health Science, Swansea University, UK
4. School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
5. Warwick Business School, University of Warwick, Coventry, UK
7. School of Human Sciences, Swansea University, Swansea, UK
8. Department of Geriatric and Stroke Medicine, Morriston Hospital, Swansea, Swansea, UK
9. Prehospital Emergency Research Unit (PERU), Welsh Ambulance Services NHS Trust, Cardiff, UK
文摘
Background Many 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/Design Pragmatic 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. Discussion Since 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 Registration ISRCTN10538608