• Adam Hewitt-Smith, Fred Bulamba, Akshaykumar Patel, Juliana Nanimambi, Lucy R Adong, Bernard Emacu, Mary Kabaleta, Justine Khanyalano, Ayub H Maiga, Charles Mugume, Joanitah Nakibuule, Loretta Nandyose, Martin Sejja, Winfred Weere, Timothy Stephens, and Rupert M Pearse.
• Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK; Department of Anaesthesia and Critical Care, Faculty of Health Sciences, Busitema University, Mbale, Uganda; Elgon Centre for Health Research and Innovation (ELCHRI), Mbale, Uganda. Electronic address: adamhewittsmith@gmail.com.
• Br J Anaesth. 2024 Oct 1; 133 (4): 846852846-852.

BackgroundMortality 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.MethodsThis 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).ResultsWe 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).ConclusionsFamily 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.Clinical Trial RegistrationNCT04341558.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.

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