Table 1 Key findings from the SAFER 1 trial

Aim: To evaluate effectiveness, safety and cost-effectiveness of computerised clinical decision support (CCDS) for paramedics attending older people who fall.

Design: A cluster randomised trial with paramedics as the unit of randomisation.

Results:

 • 17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. CCDS usage was much lower in site 1, where CCDS and electronic data capture were both new (5/235 participants = 2%), than in site 2, where electronic data capture was already in place (49/201 participants = 24%).

 • Intervention paramedics referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention.

 • Non-significant differences between groups included subsequent emergency contacts (34.6 versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS − 0.74, 95% CI − 45 2.83 to + 1.28; PCS − 0.13, 95% CI − 1.65 to + 1.39) and non-conveyance (42.0 versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However, ambulance job cycle time was 8.9 min longer for intervention patients (95% CI 2.3 to 15.3).

 • Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture, and £22,200 without.

Conclusions: Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.