The Design for Implementation: The Future of Trauma Research and Clinical Guidance series kicked off at ACS Headquarters in Chicago, February 21–22. An ambitious effort partially funded with a grant from the Agency for Healthcare Research and Quality (AHRQ), the 3-year series aims to redesign how trauma clinical guidance is developed and disseminated to ensure a more effective and equitable system.
Led by principal investigator Lacey LaGrone, MD, MPH, MA, FACS, this first conference convened a broad coalition of partners, each approaching clinical practice guidance from a unique vantage point. Together, they defined the current landscape and began to clarify an ideal future state that results in better outcomes for all patients.
The carefully curated presentations were wide-ranging, addressing fair access to, patient engagement in, historical development of, repositories for, and artificial intelligence-driven clinical guidance.
Highlights include a presentation from Andrés Rubiano, MD, PhD, MSc, who shared “Beyond One Option of Treatment of Traumatic Brain Injury—A Stratified Protocol,” which also is known as BOOTStraP. It is an example of a clinical guidance scheme that elegantly addresses the real-world problem of vastly differing care contexts and capabilities.
Rinad Beidas, PhD, professor of medical social sciences at Northwestern University in Evanston, Illinois, offered insights from the disciplines of implementation science and behavioral economics. Dr. Beidas demonstrated how modifications to the choice architecture can naturally lead to the desired behavior.
To provide the military perspective, Col. Stacy Shackelford, MD, FACS, discussed the evolution of the Joint Trauma System’s (JTS) guideline implementation effort. The JTS engages in a rigorous and rapid cycle of data collection and analysis, best practice guideline development, and ever-improving trauma care delivery. A constellation of websites, dashboards, and clear communications anchors its success.
Together, Neil Francoeur, RN, and Mark Buchner—the leaders of Tactuum, a healthcare informatics firm—and Erik Van Eaton, MD, FACS, a trauma surgeon informaticist, discussed their partnership in building the Online Clinical Care Advisories & Messages at the University of Washington in Seattle. This partnership highlighted the opportunities for fast and feasible solutions when industry, academia, and clinical contexts partner.
During breakout sessions, strategically cohorted groups fleshed out “user stories” for each segment of the trauma community—from patients to rural providers to emergency medicine and others. Insights from these groups informed a second set of breakouts where attendees began to co-design a “minimum viable product (MVP),” or an early solution to the challenges raised throughout the conference. The objectives defined by the MVP included:
- Developing an accessible (free/offline), easy-to-use platform to house existing guidance that are recommended for use
- Ensuring that guidance on the platform is consolidated, coordinated (not competing) and current
- Building a consensus around a standard for future guidance, and a use-case test with one or two clinical scenarios
Guidance must support:
- “Stratified" guidance, by (1) resource environments, (2) patient clinical characteristics (e.g., age, size), and (3) patient's social/community context, (e.g., language)
- Core function coordination and sequencing, and must minimize responsibility diffusion in multiprofessional settings, based on patients’ best outcomes—flexible enough for local adaptation
- Clarity on roles and decision criteria across the continuum of care (transport, transfer, hospital, discharge, rehab, and outpatient) and between hospitals/teams
- Optimal patient experience and healing through trauma-informed care practices
- Localization and implementation across the range of clinical settings
Designated work groups will conduct complementary research and further refine consensus in preparation for the second conference in the series, scheduled for February 2025.
The conference series is managed by the Coalition for National Trauma Research (CNTR) and hosted by the ACS.
Video recordings of the presentations are available for all to review.
