Active surveillance of perioperative myocardial infarction/injury with robotic process automation: a randomized controlled implementation trial

Study protocol - Abstract Objective: Although current guidelines recommend active surveillance for perioperative myocardial infarction/injury (PMI), implementation remains limited in most institutions worldwide because of a lack of resources. This study evaluates the effectiveness, safety, and acceptability of robotic process automation (RPA)-assisted surveillance for PMI. Methods: In this single-centre study, a newly developed RPA model is implemented into daily clinical workflows. Prior to implementation, clinical staff will complete an e-learning module to build RPA-related competencies. During the implementation phase, working days are randomized to either RPA-assisted or manual surveillance for PMI. Qualitative surveys will assess acceptability, adoption, and reach among healthcare professionals. The primary endpoints are daily workload (time spent on PMI surveillance and psychological strain) and cost-effectiveness. Secondary endpoints include appropriateness (e.g. adverse device events), fidelity, and system usability. Expected outcomes: We hypothesize that RPA-assisted surveillance will result in a relevant reduction in workload and psychological burden compared to manual surveillance, with high user acceptance and low burden of adverse device events. Clinical relevance: RPA-assisted surveillance holds significant potential to become a resource-efficient intervention that enables broader implementation of current guideline recommendations. The findings will form the basis for scaling, standardizing, and eventually certifying RPA solutions for broader clinical use and future market deployment.