PROJECT SUMMARY Postoperative opioid-induced respiratory depression (OIRD) is common and often missed with routine spot check-based monitoring of patients on the hospital ward and post-acute care areas. The evolving role of continuous portable monitoring systems is of obvious benefit in these clinical settings. There is limited evidence using retrospective and prospective observational data that continuous monitoring systems increase detection of these perturbations compared to conventional monitoring. We plan to host a consensus conference to improve definitions and innovations for identification and prevention of postoperative opioid- induced respiratory depression (OIRD). We plan to develop a set of working definitions for OIRD based on available high-quality evidence and by using the expertise of a diverse group of stakeholders available for this meeting. Our definition will be a combination of physiological variables, thresholds, durations of derangement and type of monitoring utilized. Furthermore, we will discuss frameworks for the design of future clinical trials. Most evidence so far has used advanced and continuous ward monitoring in prospective observation studies or with before and after type study designs to estimate the incidence of OIRD. Appropriate interventional studies to ascertain the effect of monitoring on OIRD are lacking. These are not easy to design or implement, because of a combination of factors on the hospital wards including but not limited to alarm fatigue, nursing staffing ratios, understanding perceptions to vital signs alarms and response times, and the inability to remove a Hawthorne effect. A highly experienced, diverse group of clinical trialists will discuss and suggest designs for innovative trial mechanisms that will circumvent some of these obstacles and provide a schematic with options for clinical trials that would be robust, easy to implement, pragmatic, and with appropriately defined patient- centric outcomes that are able to be measured accurately. Finally, we will identify opportunities for technology development collaborations to improve wireless monitoring and detection of postoperative OIRD and the use artificial intelligence to detect patterns that predict patient deterioration events in real-time. Participants will discuss how the advent of increasingly portable monitoring that includes wireless and wearable solutions on the general hospital floor is changing the landscape for patient surveillance. Since acute cardio-respiratory instability events are generally preceded by several hours of a gradual change in vital signs patterns, high fidelity monitoring allows this digital fingerprint of patient decline to be accurately tracked in real time. Participants will seek to build a consortium to advance science and improve patient safety in the context of a multi-pronged approach to OIRD prevention. In addition to publications and research this group will liaise with industry, regulatory authorities, ...