Cost and Outcome of Medical Emergency Teams (COMET) Study. Design and Rationale of a DutchMulti-Center Study

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.