Cost and Outcome of Medical Emergency Teams (COMET) Study. Design and Rationale of a DutchMulti-Center Study.
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Date
2013-01
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Abstract
Aims: Description of a study protocol to analyze the effectiveness of the sequential
implementation of a Rapid Response System (RRS) on the incidence of the composite
endpoint of cardiac arrest, unplanned ICU admission, and mortality rates.
Study Design: The COMET trial is a before-after, non-randomized multi-center trial.
Place and Duration of Study: The COMET trial was held in the Netherlands in fourteen
Dutch hospitals from April 2009 until November 2011. Each hospital included two
surgical and two general medicine nursing wards.
Methodology: Prior to the introduction of the RRS, endpoints were collected for 5
months as part of a baseline assessment. The RRS was introduced in two steps. Initially,
two tools were introduced during 7 months for early detection of the deteriorating patient:
the Modified Early Warning Score (MEWS) and for structured communication, the
Situation-Background-Assessment-Recommendation (SBAR) tool. During the next 15
months the Rapid Response Team (RRT) was operational in addition to both the
detection and communication tool. Generalized Estimating Equations (GEE) analysis of
trends in outcomes will be performed. The cost description will primarily focus on the
program costs associated with training and education sessions and the time invested in
all consultations originating from patient care on the study wards.
Conclusion: The COMET study will provide evidence on the clinical outcomes and costs
of the implementation of Rapid Response System. This will include an analysis to
explore the possible effect of a Rapid Response Team as add-on to the MEWS and
SBAR tools for early recognition of the deteriorating patient on the nursing ward.
Description
Keywords
Rapid response systems, modified early warning score, multicenter trial effectiveness, deteriorating patient
Citation
Ludikhuize Jeroen, Dijkgraaf Marcel G W, Smorenburg Susanne M, Rooij Sophia E J A de, Brunsveld-Reinders Anja H, Tangkau Peter, Fikkers Bernard G, Jonge Evert de. Cost and Outcome of Medical Emergency Teams (COMET) Study. Design and Rationale of a DutchMulti-Center Study. British Journal of Medicine and Medical Research. 2013 Jan-Mar; 3(1): 13-28.