Family supplemented patient monitoring afTEr suRgery (SMARTER) pilot trial. An intervention to train family carers to measure and document basic vital signs for surgical in-patients in a resource limited hospital in Uganda

Introduction: The African Surgical OutcomeS (ASOS) study describes the typical surgical patient in Africa as younger, lower risk and developing fewer complications compared to the global average. Despite this, they are twice as likely to die. 95% of deaths reported occurred in the post‐operative period. A leading contributor to preventable post‐operative death is unrecognised physiological deterioration due to post‐operative complications, termed 'failure to rescue'. Many deaths could be prevented by early recognition and prompt resuscitation of sick patients on the post‐operative ward. One of the biggest barriers to the early recognition of complications are very high patient to nurse ratios. Across Africa, family members routinely contribute towards patient care. It seems likely that family carers could support ward nurses by contributing to post‐operative surveillance in order to prevent deaths after surgery. We hypothesise that an intervention to train family members to monitor basic vital signs, recognise when they are abnormal and communicate this to nursing staff, will increase the rate of documented vital signs, leading to reduced in‐hospital mortality. Methods: Using an iterative process, a training programme and resources designed to assist staff to rapidly and effectively train these skills was developed. Results: A complex, task‐sharing intervention has been designed to train family members to monitor vital signs, recognise when they are abnormal and communicate this to nursing staff. This will be tested and undergo further development during a pilot, stepped‐wedge cluster randomised trial at a single site in eastern Uganda. A formal process evaluation will be conducted concurrently in order to capture and understand participant and staff opinions and concerns. Conclusion: This simple, pragmatic intervention using family members has the potential to reduce mortality following surgery by identifying patients who develop postoperative complications early. This should allow appropriate intervention, preventing further patient deterioration and death.