家庭补充术后患者监测（SMARTER）：一项试点性阶梯式楔形群组随机试验。

Family supplemented patient monitoring after surgery (SMARTER): a pilot stepped-wedge cluster-randomised trial.

机构信息

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.

出版信息

Br J Anaesth. 2024 Oct;133(4):846-852. doi: 10.1016/j.bja.2024.06.027. Epub 2024 Jul 27.

DOI:10.1016/j.bja.2024.06.027

PMID:39069451

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11443126/

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.

CLINICAL TRIAL REGISTRATION

NCT04341558.

摘要

背景

非洲手术后的死亡率是高收入国家的两倍。大多数死亡发生在病房，是因为患者术后出现并发症。家属可以为及时识别病情恶化的患者做出有意义且安全的贡献。

方法

这是一项干预措施的分步楔形集群随机试验，培训家属支持护理人员在手术后每 4 小时测量一次患者的生命体征。乌干达一家医院的四个外科病房（集群）的成年住院患者被纳入研究。集群每月以一次的频率从常规护理转变为更智能的干预措施。主要结局是从术后病房到达第 3 天（3 天）结束时测量生命体征的频率。

结果

我们于 2021 年 4 月至 10 月期间纳入了 1395 名患者。平均年龄为 28.2（5-89）岁；85.7%为女性。最常见的手术是剖宫产（74.8%）。中位数（四分位间距）生命体征的数量从对照组的 0（0-1）套增加到干预组的 3（1-8）套（发生率比 12.4，95%置信区间[CI] 8.8-17.5，P<0.001）。在常规护理组中，有 6/718（0.84%）名患者死亡，而在干预组中，有 12/677（1.77%）名患者死亡（比值比 1.32，95%CI 0.1-14.7，P=0.821）。两组患者的住院时间无差异（常规护理：2[2-3]天 vs 干预组：2[2-4]天；风险比 1.11，95%CI 0.84-1.47，P=0.44）。