SAFER 2: Support and Assessment for Fall Emergency Referrals 2

Current primary outcome measures as of 25/07/2012:
The rate of further contacts with emergency healthcare providers (999 calls, ED attendances, emergency admissions or death) - both for any cause and specifically for falls, as summarised by:
1. Proportion of patients who suffer these events
2. Interval to first event
3. Event rate

Previous primary outcome measures until 25/07/2012:
Patient outcome indicators at 1 and 6 months
(From routinely collected data from the ambulance service and ED)
- Further emergency healthcare contacts (999 call or ED attendance) for fall per recruited faller and time to first contact

Current secondary outcome measures as of 25/07/2012:
1. Duration of inpatient episodes
2. Fractures arising from further falls
3. Self-reported further falls
4. Health-related quality of life, as measured by the SF12
5. 'Fear of falling' as measured by the Modified Falls Efficacy Scale
6. Patient satisfaction as measured by the Quality of Care Monitor
7. Change in place of residence
8. Pathway of care as measured by routine ambulance service data on of proportions conveyed to ED, referred to falls service, referred to other providers, or left at scene without further care
9. Durations of: ambulance service job cycle; episode of care; time to falls service response
10. Compliance with guidelines for ambulance service clinical documentation; and referrals; and for falls services follow up
11. Costs of care to NHS and personal social services, estimated by routine data from participating services
12. Self-reported costs incurred by patients and carers
13. Views of ambulance service paramedics, managers and partners on implementation of the intervention
14. Experience and satisfaction of patients receiving the intervention

Previous secondary outcome measures until 25/07/2012:
1. Patient outcome indicators at 1 and 6 months:
1.1. Emergency hospital admission (and those that are fall related) and length of stay
1.2. Further falls: health related quality of life and self-efficacy - 'fear of falling' (Self-report questionnaire, SF-12® Health Survey, Euroqol EQ-5D, modified Falls Efficacy Scale [mFES])
1.3. Injuries related to further falls, radiologically confirmed (from ED card); place of residence (self-report questionnaire)
1.4. Deaths (from coroners/register of deaths)
1.5. Patient satisfaction and experience (self-report questionnaire, Quality of Care Monitor, semi structured interview)

2. Processes of care: (routine ambulance service, ED data)
The following data will be collected systematically throughout the trial:
2.1. Proportions at index fall: conveyed to ED; referred to falls service and other providers; left at scene with no further care
2.2. Times: spent on scene; ambulance service and total care episode; to falls service response; wider ambulance response times
2.3. Quality of care compliance with: ambulance service treatment and referral protocols including clinical documentation; falls service protocol for follow up contact
2.4. Views of ambulance service paramedics; managers and partner providers of care, concerning implementation of the service

3. Costs of care related to a fall to the NHS and personal social services, and wider system effects (routine service data):
3.1. Incurred by patients and carers, related to care provided (self-report questionnaire). Patient outcome indicators will be recorded at 1 and 6 months after index fall.