CompletedPublic Health & HealthcareBones, Joints & Muscles
Care of older people who fall: evaluation of the clinical and cost effectiveness of new protocols for emergency ambulance personnel to assess and refer to appropriate community based care
Paramedics in three ambulance services will test a new protocol that lets them decide on the spot whether an older person who has fallen needs the emergency department or can stay home with a referral to a community falls service. This matters because falls are a leading cause of emergency calls for older people, yet many who fall do not need hospital care. Current practice often defaults to transporting everyone to the emergency department, which can be distressing, costly, and unnecessary. The trial fills a gap in evidence about whether paramedics can safely redirect appropriate patients to community-based care instead. If the new protocol works, it could change how ambulance services respond to falls across the UK. Fewer older people would be taken to hospital when they do not need to be, reducing pressure on emergency departments and ambulance crews. Patients would receive more appropriate care at home, with follow-up from a falls service that could prevent future falls. The research also measures costs to the NHS and to patients and carers, so funders can judge whether the approach is worth scaling up.
View original technical description
The proposed trial will measure the costs and benefits of a new health technology - a protocol for use by emergency ambulance paramedics in the care of older people who have fallen allowing the paramedic to assess and refer appropriate patients to a community based falls service. We will carry out a randomised controlled trial in which ambulance stations in three participating services (London, Wales, East Midlands) are randomly allocated to 1) implement the new health technology (intervention group) or 2) to continue to provide care according to their standard practice (control group). Paramedics based at the stations selected for the intervention group will receive additional training, protocols and clinical support to enable them to assess older people and decide whether they need to be taken to the Emergency Department (ED) straight away, or whether they could benefit from being left at home, with a referral to a falls service. We will compare costs, processes and outcomes of care for patients aged 65 or over who have fallen and are attended by paramedics with the new protocols with those attended by paramedics delivering usual care, at 1 and 6 months. The most important outcomes are those related to further falls - subsequent 999 calls and ED attendances for falls. We will also compare between groups: all falls; fall related injuries; hospital admissions; quality of life; 'fear of falling'; satisfaction; deaths; operational measures for the services e.g. time spent on jobs; and the costs of care (and any knock on effects) to the NHS and other services and to patients and carers. We will also gather in-depth information from patients, carers and health care providers (paramedics, ambulance service managers, and falls service staff) about how the new service works, and about any factors which encourage or hinder its use
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