Paramedic Assessment of Older Adults After Falls, Including Community Care Referral Pathway: Cluster Randomized Trial

Study objective We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall. Methods We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergen...

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Bibliographic Details
Published in:Annals of emergency medicine 2017-10, Vol.70 (4), p.495-505.e28
Main Authors: Snooks, Helen A., PhD, Anthony, Rebecca, Chatters, Robin, Dale, Jeremy, PhD, Fothergill, Rachael T., Dr (Clinical), Gaze, Sarah, Halter, Mary, PhD, Humphreys, Ioan, Koniotou, Marina, Logan, Phillipa, PhD, Lyons, Ronan A., PhD, Mason, Suzanne, PhD, Nicholl, Jon, PhD, Peconi, Julie, PhD, Phillips, Ceri, PhD, Porter, Alison, PhD, Siriwardena, Aloysius Niroshan, PhD, Wani, Mushtaq, Watkins, Alan, PhD, Wilson, Lynsey, Russell, Ian T., PhD
Format: Article
Language:English
Subjects:
Accidental Falls
Aged, 80 and over
Clinical Protocols
Cluster Analysis
Community Networks
Cost-Benefit Analysis
Emergency
Emergency Medical Services
Emergency Medical Technicians
Female
Geriatric Assessment - statistics & numerical data
Humans
Male
Referral and Consultation - statistics & numerical data
United Kingdom
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Summary:Study objective We aim to determine clinical and cost-effectiveness of a paramedic protocol for the care of older people who fall. Methods We undertook a cluster randomized trial in 3 UK ambulance services between March 2011 and June 2012. We included patients aged 65 years or older after an emergency call for a fall, attended by paramedics based at trial stations. Intervention paramedics could refer the patient to a community-based falls service instead of transporting the patient to the emergency department. Control paramedics provided care as usual. The primary outcome was subsequent emergency contacts or death. Results One hundred five paramedics based at 14 intervention stations attended 3,073 eligible patients; 110 paramedics based at 11 control stations attended 2,841 eligible patients. We analyzed primary outcomes for 2,391 intervention and 2,264 control patients. One third of patients made further emergency contacts or died within 1 month, and two thirds within 6 months, with no difference between groups. Subsequent 999 call rates within 6 months were lower in the intervention arm (0.0125 versus 0.0172; adjusted difference –0.0045; 95% confidence interval –0.0073 to –0.0017). Intervention paramedics referred 8% of patients (204/2,420) to falls services and left fewer patients at the scene without any ongoing care. Intervention patients reported higher satisfaction with interpersonal aspects of care. There were no other differences between groups. Mean intervention cost was $23 per patient, with no difference in overall resource use between groups at 1 or 6 months. Conclusion A clinical protocol for paramedics reduced emergency ambulance calls for patients attended for a fall safely and at modest cost.
ISSN:0196-0644
1097-6760
DOI:10.1016/j.annemergmed.2017.01.006