Despite medical advances, major surgery remains high risk. Up to 44% of patients experience post-operative complications, which can have huge impacts for patients and the healthcare system. Early recognition of postoperative complications is crucial in reducing morbidity and preventing long term disability.
The current standard of care is intermittent manual vital signs monitoring, but new wearable remote monitors offer the benefits of continuous vital signs monitoring without limiting the patient’s mobility. The aim of this thesis was to evaluate the feasibility, acceptability and clinical impacts of CRM in a surgical population.
Two randomised controlled trials, qualitative studies involving the nursing staff and surgical patients, and an early health economic analysis provide a compelling case for the evaluation of continuous remote vital signs monitoring in a high-risk surgical population. By combining all known literature in the field with a comprehensive range of mixed methodologies, it can be concluded that a future definitive trial should be large, ideally multi-centred, with individual randomisation and clinically relevant outcomes, such as length of hospital stay. A simultaneous economic evaluation is necessary to inform decision-makers after the study is complete, and will provide an opportunity to address the gaps in the literature surrounding postoperative complications. This work has also identified a number of theories regarding the design and implementation of such an evaluation. These theories can now be used to inform future studies, in which the theories themselves can be tested on a wider population of staff, and to optimise any subsequent widespread adoption of such technologies.
