Trauma society leaders discussed ways of collaborating instead of competing on clinical guideline development.

This second year of the Design for Implementation: The Future of Trauma Research and Clinical Guidance Conference Series built on last year’s work to arrive at a shared understanding of shortcomings in the ways that guidance is developed, disseminated and implemented. Participants this year began to co-design and beta-test remedies to what plagues the system, with the ultimate objective of improving patient outcomes.

To keep the focus on patients, the keynote addresses each day were delivered by Julie Ford, a survivor of violence, and LJ Punch, MD, founder of the Bullet Related Injury Clinic (BRIC) in St. Louis that provides outpatient care for bullet wound survivors. “Centering patients isn’t so much about bringing patients into clinical world,” said Dr. Punch, “Patients ARE the point—they are the center.”

“It takes 17 years on average for research findings to make their way into clinical practice,” said Eileen Bulger, MD, ACS

Dr. LJ Punch encouraged individuals to consider their power position in the healthcare ecosystem.

Medical Director of Trauma Programs, in her opening remarks. “But even then, a hospital may or may not have access to the research, and practitioners may or may not be able to find it in time to help the patient in front of them.”

Lacey LaGrone, MD, MPH, conference PI, believes that now is the right time in history to solve this problem—with the evolution of generative AI and FHIR/HL7 standardization, the rise of open access platforms, and aligned incentives among the rural U.S., military and global majority healthcare systems. “We’ve gotten as much as we possibly can out of the current system, said LaGrone, “Now, it needs to change.”

Between the first and second years of the conference series, LaGrone’s team conducted interviews with rural care providers and the emergency medicine community and reviewed injury care across the Americas. They also worked with tech firm Tactuum to develop a beta version of an open access clinical guidelines repository. In breakout sessions, attendees tested the app and provided feedback on format, categories, searchability, aesthetics and other features.

Conference participants provided feedback on the beta version of a clinical guidance application.

Interconnectedness will be necessary to move forward with a better clinical guidance system, and leaders of ACS-COT, AAST, EAST, WTA, SCCM, and STN discussed ways to collaborate instead of compete. “We need to get out of the mindset that a guideline belongs to one or another organization,” said one society leader.

There was general agreement that the Coalition for National Trauma Research (CNTR) is the natural place to house a central guideline repository. An Evidence-to-Practice Committee is being formed within CNTR that will include representation from these and other U.S. and international organizations that develop clinical guidance.

As part of a moderated panel, Simon Oczkowski, MD (McMaster); Kristan Staudenmayer, MD (Stanford); Christopher Tignanelli, MD (Minnesota); and Mitch Cohen, MD (Colorado) talked about applications they are building at their institutions that enable evidence synthesis, decision support, live dashboards and/or real-time patient data capture. Their health systems are partnering with various companies including Creative Bits AI, Stanson, Tactuum, and T6 Health Systems. Dr. Staudenmayer made clear that these systems do not leave decision-making to machines. “We are trusting AI to assemble the information for the humans to make the decisions,” she said.

Notre Dame librarian Natalie Meyers warned that using AI is not to be taken lightly: responsible use of AI requires a robust governing structure that includes elements such as acceptable use policies, oversight committees, training, ongoing monitoring, bias testing, vendor due diligence, and more.

Several organizations presented their guideline development approaches, including the National Comprehensive Cancer Network, the Defense Health Agency, and the Joint Trauma System.

It became clear: many brilliant people are working on fixing what ails the clinical guidance ecosystem. “But these things aren’t solvable if we keep doing different things at different institutions,” insisted Dr. Cohen.

It also was clear that simply making guidelines available doesn’t result in physicians routinely using research to inform care. Implementation scientist Molly McNett, PhD, RN, explained, “Actual implementation requires relevant topics, timely delivery, meaningful and useful mechanisms, and policy changes.” Sustainable implementation requires buy-in from system leaders and healthcare team members.

Synthesizing the discussion, Dr. LaGrone laid out a new approach to clinical guidance generation and implementation that is: hybrid synchronous/asynchronous, AI-accelerated, subject matter expert-owned and driven, resource-stratified, evidence-informed, and ethicist-regulated. Participants began to imagine what such a system could look like and how it might be structured to ensure rigor, transparency, and equity.

In the final sessions of the conference, speakers agreed that we must leverage work already being done and that the existing power structure must be upended. Ashley Farley, a program officer at the Gates Foundation, said their current policies deemphasize reliance on commercially produced journals as the version of record. “We want the power to stay with the researcher,” she said.

Anna Maw, MD, a health services researcher at the University of Colorado, pointed to misaligned incentives in the system and how they have hindered better outcomes. “EPIC doesn’t have incentive to be responsive to the kind of data we’re interested in capturing. EHR systems weren’t developed for quality improvement or improving outcomes—they are primarily billing tools. And health systems that run on thin margins will only measure what is required,” she said.

The conference ended with summaries of the breakout sessions. Users’ wish lists for the clinical guidance repository include a chatbot, voice activation, algorithms, interaction, and use cases with customization based on patient profiles. They want the highest quality of information that is trust-worthy, and they’d like it linked to patient data.

Asserting that “Doing the right thing is always the right thing,” Dr. LaGrone closed with next steps. Research on clinical guidance development continues between conferences with the support of an AAST scholarship. Other grant applications have been or will be submitted in the coming months to support the integration of AI into guideline development and dissemination and the application of implementation science to improve the uptake of clinical guidance among providers. With a focus on solution refinement, sustainability and impact assessment, the final conference in the DFI series will be held in February 2026.

[Funding for this conference was made possible (in part) by grant number 1R13HS028940-01A1 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.]