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[Preprint]. 2025 Aug 24:2025.08.20.25334072.

doi: 10.1101/2025.08.20.25334072.

Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation

Jenny M Guido¹, Morgan Krause², Brendon Frankel³, Emily Hillmer⁴, Ariel W Knight⁵, Katheryn Grider⁶, Ashley N Moreno⁷, Lacey N LaGrone⁸; 2025 Design for Implementation (DFI) Authorship Group; Pamela Bixby⁹, Stephanie Bonne¹⁰, Eileen M Bulger¹¹, James G Cain¹², Jennifer Chastek¹³, Julia Roberts Coleman¹⁴, Todd W Costantini¹⁵, Nicholas Cozzi¹⁶, Kimberly A Davis¹⁷, Rochelle A Dicker¹⁸, Warren C Dorlac¹⁹, Erik Van Eaton²⁰, Evert Eriksson²¹, Susan Evans²², Shannon Marie Foster²³, Jeffrey M Goodloe²⁴, Elliott R Haut²⁵, Molly Jarman²⁶, Alyssa Johnson²⁷, Meera Kotagal²⁸, Morgan Krause²⁹, John C Kubasiak³⁰, Kelly Lang³¹, Allison Barbara Leigh³², Halinder S Mangat³³, Debra Marie Marvel³⁴, Christopher Paul Michetti³⁵, Vicki Moran³⁶, Ashley N Moreno³⁷, Simon Jw Oczkowski³⁸, Michael A Person³⁹, Michelle A Price⁴⁰, L J Punch⁴¹, Megan Racey⁴², Bradford L Ray⁴³, Diane Redmond⁴⁴, Linda Kate Reinhart⁴⁵, Heather Rhodes⁴⁶, Bryn Rhodes⁴⁷, Andres M Rubiano⁴⁸, Sabrina Sanchez⁴⁹, Babak Sarani⁵⁰, Erica Shelton⁵¹, David A Spain⁵², Kristan Staudenmayer⁵³, Deborah M Stein⁵⁴, Julie Valenzuela⁵⁵, Cynthia Lizette Villarreal⁵⁶, Jeffrey L Wells⁵⁷, Gabriela Zavala Wong⁵⁸, LeAnne Sitari Young⁵⁹

Affiliations

¹ Sanford USD Medical Center, University of South Dakota Sanford School of Medicine; Sioux Falls, SD, USA.
² Northeast Georgia Health System; Gainesville, GA, USA.
³ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ University of South Dakota Sanford School of Medicine; Sioux Falls, SD, USA.
⁵ Stanford University Department of Surgery, Stanford, CA, USA.
⁶ ADT, Whitefish, MT, USA.
⁷ Coalition for National Trauma Research (CNTR), San Antonio, TX, USA.
⁸ Medical Center of the Rockies, UCHealth; Loveland, CO, USA.
⁹ Deputy Director, Coalition for National Trauma Research; San Antonio, TX, USA.
¹⁰ Professor of Surgery, Advocate Christ Medical Center, Department of Surgery, Oak Lawn, IL, USA, Professor of Surgery, Wake Forest School of Medicine, Department of Surgery, Winston-Salem, NC, USA.
¹¹ Professor of Surgery & Division Chief, Trauma, Burns, and Critical Care, USA, University of Washington, Seattle, WA, USA, Chief of Surgery, Harborview Medical Center, Seattle, WA, USA.
¹² Department Chair and Professor of Anesthesiology, University of Florida College of Medicine Jacksonville, Department of Anesthesiology, Jacksonville, FL, USA.
¹³ Certified Registered Nurse Anesthetist, Iowa Anesthesia LC, Manchester, IA, USA.
¹⁴ Assistant Professor, Department of Surgery, Columbus, OH, USA.
¹⁵ Professor of Surgery, Division of Critical Care and Acute Care Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁶ Assistant Professor, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Division Chief, General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine Department of Surgery, New Haven, CT, USA.
¹⁸ Professor of Surgery, UCSF, San Francisco, CA, USA.
¹⁹ Vice Chair, COT, University of Colorado, Associate Trauma Medical Director, Medical Center of the Rockies, Loveland, CO, USA.
²⁰ Associate Professor, Department of Surgery, University of Washington, Seattle, WA, USA.
²¹ Professor of Surgery, Medical University of South Carolina, Department of Surgery, Charleston, SC, USA.
²² Professor of Surgery, Wake Forest School of Medicine, Vice Chair Research, Department of Surgery, Winston-Salem, NC, USA, Atrium Health.
²³ Acute Care Surgeon, Contractor, Director, SMF Coverage & Solutions LLC, Reading, PA, USA.
²⁴ Professor, University of OK School of Community Medicine; Department of Emergency Medicine; Tulsa, OK, USA, National Liaison to ACS COT; Board Member, American College of Emergency Physicians; Irving, TX, USA.
²⁵ Professor, Johns Hopkins University School of Medicine; Baltimore, MD, USA.
²⁶ Lead Investigator, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA, Assistant Professor, Department of Surgery, Harvard Medical School, Boston, MA, USA.
²⁷ Montana Trauma System Manager, Dept. of Public Health & Human Services, Helena, MT, USA.
²⁸ Assistant Professor, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA, Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²⁹ Trauma Nurse Research Coordinator, Northeast Georgia Medical Center, Gainesville, GA, USA.
³⁰ Assistant Professor of Surgery, Loyola University Chicago, Maywood, IL, USA.
³¹ Author, Speaker, Advocate, The Miracle Child; Leesburg, VA, USA.
³² Medical Student, University of Colorado School of Medicine's Fort Collins Branch, Aurora, CO, USA.
³³ Associate Professor, Kansas University Medical Center, Kansas City, KS, USA, Director of Research, Brain Trauma Foundation, Palo Alto, CA, USA.
³⁴ Patient Representative, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, Patient Advocate, CNTR, San Antonio, Texas.
³⁵ Chief of Trauma, Professor of Surgery, University of Maryland Capital Region Medical Center, Department of Surgery, Largo, MD, USA.
³⁶ Associate Professor of Nursing, Saint Louis University; St. Louis, MO, USA, Trauma Research Coordinator, SSM Health Saint Louis University Hospital, MO, USA.
³⁷ Research Associate, Coalition for National Trauma Research; San Antonio, TX, USA.
³⁸ Associate Professor, Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
³⁹ Associate Professor, University of South Dakota; Sioux Falls, SD, USA.
⁴⁰ Executive Director, Coalition for National Trauma Research; San Antonio, TX, USA, Adjunct Professor, UT Health San Antonio, TX, USA.
⁴¹ Medical Director, The Bullet Related Injury Clinic, St. Louis, MO, USA.
⁴² Research Coordinator, McMaster University, Hamilton, Ontario, Canada.
⁴³ Director. Patient Blood Management & Research, University Medical Center, El Paso, Texas, USA, Clinical Instructor, Trauma, General Surgery El Paso, Texas, USA.
⁴⁴ Trauma- Clinical Research Nurse, Penrose Hospital, Trauma Services, Colorado Springs, CO, USA.
⁴⁵ Trauma Program Manager, St. Luke's University Health Network-Grand View Campus, Sellersville, PA, USA, Past President, Society of Trauma Nurses Organization, Lexington, KY, USA.
⁴⁶ Trauma Scientist, Center for Clinical Epidemiology and Population Health, Marshfield, WI, USA.
⁴⁷ Director of Standards Strategy, Smile Digital Health, Toronto, ON, USA.
⁴⁸ Professor of Neurosciences and Neurosurgery, Universidad El Bosque, Bogota, Colombia, Medical and Research Director, Meditech Foundation, Cali, Colombia.
⁴⁹ Associate Professor of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, Attending Surgeon, Boston Medical Center, Boston, MA, USA.
⁵⁰ Professor of Surgery and Emergency Medicine, George Washington University, Washington, DC, USA.
⁵¹ Assistant Professor, Department of Emergency Medicine, Johns Hopkins University; Baltimore, MD, USA.
⁵² Professor of Surgery, Stanford University, Stanford, CA, USA.
⁵³ Associate Professor of Surgery, Stanford University, Stanford, CA, USA, Chair, ACS COT Trauma Systems, COT, Chicago, IL.
⁵⁴ Professor of Surgery, University of Maryland School of Medicine Program in Trauma, Baltimore, MD, USA.
⁵⁵ Assistant Professor of Surgery, University of Miami Miller School of Medicine, Surgery, Miami, FL, USA, Director of Community Engaged Research, Outreach, and Advocacy, William Lehman Injury, Research Center.
⁵⁶ Director of Applied Research, Coalition for National Trauma Research; San Antonio, TX, USA.
⁵⁷ Non-Scientist IRB Member, Univ. MD, Baltimore, USA, Non-Scientist IRB Member, NIH Bethesda, MD, USA.
⁵⁸ Research Scientist, Medical Center of the Rockies, UCHealth, Loveland, CO, USA, Sociedad de Cirujanos Generales del Peru, Lima, Peru, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru.
⁵⁹ Assistant Clinical Director of Trauma and Injury Prevention, Texas Children's Hospital, Trauma Services, Houston, TX, Immediate Past President, Society of Trauma Nurses.

PMID: 40894154
PMCID: PMC12393620
DOI: 10.1101/2025.08.20.25334072

Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation

Jenny M Guido et al. medRxiv. 2025.

[Preprint]. 2025 Aug 24:2025.08.20.25334072.

doi: 10.1101/2025.08.20.25334072.

Authors

Affiliations

¹ Sanford USD Medical Center, University of South Dakota Sanford School of Medicine; Sioux Falls, SD, USA.
² Northeast Georgia Health System; Gainesville, GA, USA.
³ University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
⁴ University of South Dakota Sanford School of Medicine; Sioux Falls, SD, USA.
⁵ Stanford University Department of Surgery, Stanford, CA, USA.
⁶ ADT, Whitefish, MT, USA.
⁷ Coalition for National Trauma Research (CNTR), San Antonio, TX, USA.
⁸ Medical Center of the Rockies, UCHealth; Loveland, CO, USA.
⁹ Deputy Director, Coalition for National Trauma Research; San Antonio, TX, USA.
¹⁰ Professor of Surgery, Advocate Christ Medical Center, Department of Surgery, Oak Lawn, IL, USA, Professor of Surgery, Wake Forest School of Medicine, Department of Surgery, Winston-Salem, NC, USA.
¹¹ Professor of Surgery & Division Chief, Trauma, Burns, and Critical Care, USA, University of Washington, Seattle, WA, USA, Chief of Surgery, Harborview Medical Center, Seattle, WA, USA.
¹² Department Chair and Professor of Anesthesiology, University of Florida College of Medicine Jacksonville, Department of Anesthesiology, Jacksonville, FL, USA.
¹³ Certified Registered Nurse Anesthetist, Iowa Anesthesia LC, Manchester, IA, USA.
¹⁴ Assistant Professor, Department of Surgery, Columbus, OH, USA.
¹⁵ Professor of Surgery, Division of Critical Care and Acute Care Surgery, University of Minnesota Medical School, Minneapolis, MN, USA.
¹⁶ Assistant Professor, Rush University Medical Center, Chicago, IL, USA.
¹⁷ Division Chief, General Surgery, Trauma and Surgical Critical Care, Yale School of Medicine Department of Surgery, New Haven, CT, USA.
¹⁸ Professor of Surgery, UCSF, San Francisco, CA, USA.
¹⁹ Vice Chair, COT, University of Colorado, Associate Trauma Medical Director, Medical Center of the Rockies, Loveland, CO, USA.
²⁰ Associate Professor, Department of Surgery, University of Washington, Seattle, WA, USA.
²¹ Professor of Surgery, Medical University of South Carolina, Department of Surgery, Charleston, SC, USA.
²² Professor of Surgery, Wake Forest School of Medicine, Vice Chair Research, Department of Surgery, Winston-Salem, NC, USA, Atrium Health.
²³ Acute Care Surgeon, Contractor, Director, SMF Coverage & Solutions LLC, Reading, PA, USA.
²⁴ Professor, University of OK School of Community Medicine; Department of Emergency Medicine; Tulsa, OK, USA, National Liaison to ACS COT; Board Member, American College of Emergency Physicians; Irving, TX, USA.
²⁵ Professor, Johns Hopkins University School of Medicine; Baltimore, MD, USA.
²⁶ Lead Investigator, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA, Assistant Professor, Department of Surgery, Harvard Medical School, Boston, MA, USA.
²⁷ Montana Trauma System Manager, Dept. of Public Health & Human Services, Helena, MT, USA.
²⁸ Assistant Professor, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA, Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²⁹ Trauma Nurse Research Coordinator, Northeast Georgia Medical Center, Gainesville, GA, USA.
³⁰ Assistant Professor of Surgery, Loyola University Chicago, Maywood, IL, USA.
³¹ Author, Speaker, Advocate, The Miracle Child; Leesburg, VA, USA.
³² Medical Student, University of Colorado School of Medicine's Fort Collins Branch, Aurora, CO, USA.
³³ Associate Professor, Kansas University Medical Center, Kansas City, KS, USA, Director of Research, Brain Trauma Foundation, Palo Alto, CA, USA.
³⁴ Patient Representative, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, Patient Advocate, CNTR, San Antonio, Texas.
³⁵ Chief of Trauma, Professor of Surgery, University of Maryland Capital Region Medical Center, Department of Surgery, Largo, MD, USA.
³⁶ Associate Professor of Nursing, Saint Louis University; St. Louis, MO, USA, Trauma Research Coordinator, SSM Health Saint Louis University Hospital, MO, USA.
³⁷ Research Associate, Coalition for National Trauma Research; San Antonio, TX, USA.
³⁸ Associate Professor, Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
³⁹ Associate Professor, University of South Dakota; Sioux Falls, SD, USA.
⁴⁰ Executive Director, Coalition for National Trauma Research; San Antonio, TX, USA, Adjunct Professor, UT Health San Antonio, TX, USA.
⁴¹ Medical Director, The Bullet Related Injury Clinic, St. Louis, MO, USA.
⁴² Research Coordinator, McMaster University, Hamilton, Ontario, Canada.
⁴³ Director. Patient Blood Management & Research, University Medical Center, El Paso, Texas, USA, Clinical Instructor, Trauma, General Surgery El Paso, Texas, USA.
⁴⁴ Trauma- Clinical Research Nurse, Penrose Hospital, Trauma Services, Colorado Springs, CO, USA.
⁴⁵ Trauma Program Manager, St. Luke's University Health Network-Grand View Campus, Sellersville, PA, USA, Past President, Society of Trauma Nurses Organization, Lexington, KY, USA.
⁴⁶ Trauma Scientist, Center for Clinical Epidemiology and Population Health, Marshfield, WI, USA.
⁴⁷ Director of Standards Strategy, Smile Digital Health, Toronto, ON, USA.
⁴⁸ Professor of Neurosciences and Neurosurgery, Universidad El Bosque, Bogota, Colombia, Medical and Research Director, Meditech Foundation, Cali, Colombia.
⁴⁹ Associate Professor of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA, Attending Surgeon, Boston Medical Center, Boston, MA, USA.
⁵⁰ Professor of Surgery and Emergency Medicine, George Washington University, Washington, DC, USA.
⁵¹ Assistant Professor, Department of Emergency Medicine, Johns Hopkins University; Baltimore, MD, USA.
⁵² Professor of Surgery, Stanford University, Stanford, CA, USA.
⁵³ Associate Professor of Surgery, Stanford University, Stanford, CA, USA, Chair, ACS COT Trauma Systems, COT, Chicago, IL.
⁵⁴ Professor of Surgery, University of Maryland School of Medicine Program in Trauma, Baltimore, MD, USA.
⁵⁵ Assistant Professor of Surgery, University of Miami Miller School of Medicine, Surgery, Miami, FL, USA, Director of Community Engaged Research, Outreach, and Advocacy, William Lehman Injury, Research Center.
⁵⁶ Director of Applied Research, Coalition for National Trauma Research; San Antonio, TX, USA.
⁵⁷ Non-Scientist IRB Member, Univ. MD, Baltimore, USA, Non-Scientist IRB Member, NIH Bethesda, MD, USA.
⁵⁸ Research Scientist, Medical Center of the Rockies, UCHealth, Loveland, CO, USA, Sociedad de Cirujanos Generales del Peru, Lima, Peru, Universidad Peruana Cayetano Heredia School of Medicine, Lima, Peru.
⁵⁹ Assistant Clinical Director of Trauma and Injury Prevention, Texas Children's Hospital, Trauma Services, Houston, TX, Immediate Past President, Society of Trauma Nurses.

PMID: 40894154
PMCID: PMC12393620
DOI: 10.1101/2025.08.20.25334072

Abstract

Introduction: In trauma care, there is a need to increase communication to ensure evidence-informed, best practice care guidelines are easily accessible to all providers to yield continuity of care. Clinical guidance use is one way to address this need while employing a patient-centered team approach.

Methods: During year two of the Design for Implementation: The Future of Trauma Research & Clinical Guidance conference series, participants gathered in person and virtually to further develop the Minimum Viable Product (MVP) created during year one. Professional facilitators used the purpose-to-practice (P2P) framework to help structure and guide further consensus building.

Results: Seventy in-person and up to 65 virtual attendees participated. Sixty-five responses were collected on the MVP reflection and initial feedback survey. Themes were developed surrounding the pillars of "Purpose," "Principles," "Participants," and "Practices" while looking at the "Structure" for "Sustainability." The "Purpose" pillar addressed the importance of rigorous, standardized implementation guidance. "Principles" exemplified the necessity of a collaborative approach and included all relevant stakeholders. Similarly, the central theme emphasized by the "Participants" pillar was the inclusiveness of all members of the trauma team. "Practices" dove into the deliverables of the initiative, including up-to-date decision-making support and logistics regarding guidance storage, management, and maintenance. Regarding "Structure," the most highly ranked idea was developing a steering committee whose purpose would be primarily to prioritize strategic initiatives.

Discussion: Clinical guidance needs to be current and readily available to all providers. Next steps of this initiative include developing a steering committee and subcommittees to sustain momentum.

Keywords: clinical practice guidance; minimum viable product; purpose-to-practice; trauma.

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Conflict of interest statement

Katheryn Grider, Ashley Moreno, and Lacey LaGrone report funding for the DFI conference was made possible in part by grant 1R13HS028940-01A1 from the Agency for Healthcare Research and Quality (AHRQ) paid to the Coalition for National Trauma Research. The AHRQ grant covered part of their costs for attending the conference. Ashley Moreno received financial support from The ReSource, LLC for additional DFI conference support. The Coalition for National Trauma Research has received a grant from the Gates Foundation to support the ongoing and adjacent DFI work. Within the 2025 Design for Implementation (DFI) Authorship Group: Babak Sarani is a consultant for Haemonetics, Belmont, and Acumed, and a speaker for Haemonetics, Acumed, and Medtronic. Deborah M. Stein is a consultant for CSL Behring. Erik Van Eaton is a paid employee and shareowner at TransformativeMed Inc. (a health IT software company). Evert Eriksson is a speaker and educator for J&J and AO. Simon Oczkowski has received travel support from Fisher & Paykel Healthcare, and consulting fees from VitalAire and The Brain Trauma Foundation. Kristan Staudenmayer is a consultant for AIMedica and Credence Management Solutions. Jeffrey L. Wells and Kelly Lang each received a stipend for their DFI conference participation as trauma survivors/a caregiver from the ReSource, LLC. Elliott R. Haut reports research funding from AHRQ, PCORI, NIH/NHLBI. Dr. Haut is also the Editor of Trauma Surgery & Acute Care Open (TSACO). Simon Oczkowski has received travel support from Fisher & Paykel Healthcare, and consulting fees from VitalAire and The Brain Trauma Foundation.

Figures

**Figure 1.**
The Five Elements of the Purpose-to-Practice Framework

**Figure 2.**
Results of the dot voting exercise and areas of most importance

See this image and copyright information in PMC

References

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This is a preprint.

Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation

Affiliations

Application of Evidence into Practice in Trauma: The Purpose to Practice (P2P) Approach to Consensus Generation

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous