Abstract：
BACKGROUND: Mortality after surgery in Africa is twice that in high-income countries. Most deaths occur on wards after patients develop postoperative complications. Family members might contribute meaningfully and safely to early recognition of deteriorating patients.
METHODS: This was a stepped-wedge cluster-randomised trial of an intervention training family members to support nursing staff to take and record patient vital signs every 4 h after surgery. Adult inpatients across four surgical wards (clusters) in a Ugandan hospital were included. Clusters crossed once from routine care to the SMARTER intervention at monthly intervals. The primary outcome was frequency of vital sign measurements from arrival on the postoperative ward to the end of the third postoperative day (3 days).
RESULTS: We enrolled 1395 patients between April and October 2021. Mean age was 28.2 (range 5-89) yr; 85.7% were female. The most common surgical procedure was Caesarean delivery (74.8%). Median (interquartile range) number of sets of vital signs increased from 0 (0-1) in control wards to 3 (1-8) in intervention wards (incident rate ratio 12.4, 95% confidence interval [CI] 8.8-17.5, P<0.001). Mortality was 6/718 (0.84%) patients in the usual care group vs 12/677 (1.77%) in the intervention group (odds ratio 1.32, 95% CI 0.1-14.7, P=0.821). There was no difference in length of hospital stay between groups (usual care: 2 [2-3] days vs intervention: 2 [2-4] days; hazard ratio 1.11, 95% CI 0.84-1.47, P=0.44).
CONCLUSIONS: Family member supplemented vital signs monitoring substantially increased the frequency of vital signs after surgery. Care interventions involving family members have the potential to positively impact patient care.
BACKGROUND: NCT04341558.
METHODS: This was a stepped-wedge cluster-randomised trial of an intervention training family members to support nursing staff to take and record patient vital signs every 4 h after surgery. Adult inpatients across four surgical wards (clusters) in a Ugandan hospital were included. Clusters crossed once from routine care to the SMARTER intervention at monthly intervals. The primary outcome was frequency of vital sign measurements from arrival on the postoperative ward to the end of the third postoperative day (3 days).
RESULTS: We enrolled 1395 patients between April and October 2021. Mean age was 28.2 (range 5-89) yr; 85.7% were female. The most common surgical procedure was Caesarean delivery (74.8%). Median (interquartile range) number of sets of vital signs increased from 0 (0-1) in control wards to 3 (1-8) in intervention wards (incident rate ratio 12.4, 95% confidence interval [CI] 8.8-17.5, P<0.001). Mortality was 6/718 (0.84%) patients in the usual care group vs 12/677 (1.77%) in the intervention group (odds ratio 1.32, 95% CI 0.1-14.7, P=0.821). There was no difference in length of hospital stay between groups (usual care: 2 [2-3] days vs intervention: 2 [2-4] days; hazard ratio 1.11, 95% CI 0.84-1.47, P=0.44).
CONCLUSIONS: Family member supplemented vital signs monitoring substantially increased the frequency of vital signs after surgery. Care interventions involving family members have the potential to positively impact patient care.
BACKGROUND: NCT04341558.
摘要：
背景：非洲手术后死亡率是高收入国家的两倍。大多数死亡发生在患者发生术后并发症后的病房。家庭成员可能有助于有意义和安全的早期识别恶化的患者。
方法：这是一项针对干预性培训家庭成员以支持护理人员在手术后每4小时采集并记录患者生命体征的阶梯式分组随机试验。包括乌干达医院四个手术室（集群）的成年住院患者。每个月从常规护理到SMARTER干预的集群交叉一次。主要结果是从到达术后病房到术后第三天（3天）结束的生命体征测量频率。
结果：我们在2021年4月至10月之间招募了1395名患者。平均年龄为28.2岁（5-89岁）；85.7％为女性。最常见的外科手术是剖腹产（74.8%）。生命体征的中位数（四分位数范围）从对照组的0（0-1）增加到干预病房的3（1-8）（发生率比12.4，95％置信区间[CI]8.8-17.5，P<0.001）。常规治疗组的死亡率为6/718（0.84%），干预组为12/677（1.77%）（比值比1.32，95%CI0.1-14.7，P=0.821）。两组之间的住院时间没有差异（常规护理：2[2-3]天vs干预：2[2-4]天；风险比1.11，95％CI0.84-1.47，P=0.44）。
结论：家庭成员补充生命体征监测大大增加了手术后生命体征的频率。涉及家庭成员的护理干预措施有可能对患者护理产生积极影响。
背景：NCT04341558。
方法：这是一项针对干预性培训家庭成员以支持护理人员在手术后每4小时采集并记录患者生命体征的阶梯式分组随机试验。包括乌干达医院四个手术室（集群）的成年住院患者。每个月从常规护理到SMARTER干预的集群交叉一次。主要结果是从到达术后病房到术后第三天（3天）结束的生命体征测量频率。
结果：我们在2021年4月至10月之间招募了1395名患者。平均年龄为28.2岁（5-89岁）；85.7％为女性。最常见的外科手术是剖腹产（74.8%）。生命体征的中位数（四分位数范围）从对照组的0（0-1）增加到干预病房的3（1-8）（发生率比12.4，95％置信区间[CI]8.8-17.5，P<0.001）。常规治疗组的死亡率为6/718（0.84%），干预组为12/677（1.77%）（比值比1.32，95%CI0.1-14.7，P=0.821）。两组之间的住院时间没有差异（常规护理：2[2-3]天vs干预：2[2-4]天；风险比1.11，95％CI0.84-1.47，P=0.44）。
结论：家庭成员补充生命体征监测大大增加了手术后生命体征的频率。涉及家庭成员的护理干预措施有可能对患者护理产生积极影响。
背景：NCT04341558。
