Family supplemented patient monitoring : an intervention to prevent failure to rescue after surgery in Ugandan hospitals.
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Date
2025
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Queen Mary University of London
Abstract
Background: Patients who have surgery in Uganda are twice as likely to die compared the global
average, despite being younger and fitter. Most deaths happen on the hospital wards after surgery
following post-operative complications. There is limited evidence of ways to reduce this ‘failure to
rescue’ in these settings. Interventions that utilise existing resources such as family members need
to be developed and explored further.
Methods: This thesis includes a systematic review, one-year observational cohort study, steppedwedge cluster randomised controlled trial, and concurrent mixed methods process evaluation
which together describe the development and testing of a complex intervention to deliver family
supplemented patient monitoring after surgery at the Mbale Regional Referral Hospital in Uganda. I
compared the total number of sets of vital signs using an incident rate ratio and used logistic
regression to analyse mortality after surgery. Qualitative data were analysed with a deductive
approach using the consolidated framework for intervention research.
Results: 93/4773 (2.0%) patients having surgery died before hospital discharge. This rises to
68/304 (22.4%) for patients undergoing elective or emergency laparotomy. 73/83 (88.0%) of these
deaths occur on the postoperative wards. During the SMARTER pilot trial of 1395 patients in four
hospital wards, the median (IQR) number of sets of vital signs monitoring per three-day study
period in the usual care group was 0 [0-1] compared with 3 [1-8] in the intervention group, where
family members supplemented vital signs monitoring of patients after surgery (Incident rate ratio:
12.4 [8.8 to 17.5], p=<0.001). My process evaluation identified both positive factors influencing the
intervention such as the ‘relative advantage’, and negative factors such as the ‘available
resources’, ‘culture’ and ‘compatibility’.
Conclusions: Family supplemented patient monitoring results in significantly higher rates of vital
signs monitoring for patients after surgery. This intervention was successfully implemented in a
low-resource regional hospital in Uganda
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Hewitt-Smith, A. (2025). Family supplemented patient monitoring : an intervention to prevent failure to rescue after surgery in Ugandan hospitals. Queen Mary University of London.