A Better Way: Initial Acceptability Testing of Using Artificial Intelligence Tools to Accelerate Development of Trauma Clinical Guidance

A Better Way: Initial Acceptability Testing of Using Artificial Intelligence Tools to Accelerate Development of Trauma Clinical Guidance | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search A Better Way: Initial Acceptability Testing of Using Artificial Intelligence Tools to Accelerate Development of Trauma Clinical Guidance View ORCID Profile Gabriela Zavala Wong , Shannon Rosenauer , Chelsea Church , Diana Sherifali , View ORCID Profile Megan Racey , Katheryn Grider , View ORCID Profile Ashley N. Moreno , View ORCID Profile Lacey N. LaGrone , The 2025 Design for Implementation (DFI) Authorship Group , Pamela Bixby , Stephanie Bonne , Eileen M. Bulger , James G Cain , Jennifer Chastek , Julia Roberts Coleman , Todd W Costantini , Nicholas Cozzi , Kimberly A. Davis , Rochelle A. Dicker , Warren C. Dorlac , Erik Van Eaton , Evert Eriksson , Susan Evans , Shannon Marie Foster , Jeffrey M. Goodloe , Elliott R. Haut , Molly Jarman , Alyssa Johnson , Meera Kotagal , Morgan Krause , John C. Kubasiak , Kelly Lang , Allison Barbara Leigh , Halinder S. Mangat , Debra Marie Marvel , Christopher Paul Michetti , Vicki Moran , Ashley N. Moreno , Simon JW Oczkowski , Michael A. Person , Michelle A. Price , LJ Punch , Megan Racey , Bradford L. Ray , Diane Redmond , Linda Kate Reinhart , Heather Rhodes , Bryn Rhodes , Andres M. Rubiano , Sabrina Sanchez , Babak Sarani , Erica Shelton , David A Spain , Kristan Staudenmayer , Deborah M. Stein , Julie Valenzuela , Cynthia Lizette Villarreal , Jeffrey L. Wells , Gabriela Zavala Wong , LeAnne Sitari Young doi: https://doi.org/10.1101/2025.08.20.25334097 Gabriela Zavala Wong 1 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 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Gabriela Zavala Wong For correspondence: gabriela.zavalawong{at}uchealth.org gabrielazavalaw{at}gmail.com Shannon Rosenauer 2 Boston Consulting Group (BCG) , Denver, CO, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Chelsea Church 3 Boston Consulting Group (BCG) , Denver, CO, USA MBA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Diana Sherifali 4 McMaster University , Hamilton, Ontario, Canada RN, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Megan Racey 5 McMaster University , Hamilton, Ontario, Canada PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Megan Racey Katheryn Grider 6 ADT , Whitefish, MT, USA BA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ashley N. Moreno 7 Coalition for National Trauma Research; San Antonio , TX, US MS Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Ashley N. Moreno Lacey N. LaGrone 8 Medical Center of the Rockies, UCHealth ; Loveland, CO, USA MD, MPH, MA Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Lacey N. LaGrone 9 Coalition for National Trauma Research; San Antonio , TX, USA Pamela Bixby 10 Coalition for National Trauma Research ; San Antonio, TX, USA MA Roles: Deputy Director Find this author on Google Scholar Find this author on PubMed Search for this author on this site Stephanie Bonne 11 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 MD Roles: Professor of Surgery Find this author on Google Scholar Find this author on PubMed Search for this author on this site Eileen M. Bulger 12 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 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site James G Cain 13 Department Chair and Professor of Anesthesiology, University of Florida College of Medicine Jacksonville , Department of Anesthesiology, Jacksonville, FL, USA MD, MBA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jennifer Chastek 14 Certified Registered Nurse Anesthetist Iowa Anesthesia LC , Manchester, IA, USA DNAP Find this author on Google Scholar Find this author on PubMed Search for this author on this site Julia Roberts Coleman 15 Department of Surgery , Columbus, OH, USA MD, MPH Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Todd W Costantini 16 Division of Critical Care and Acute Care Surgery, University of Minnesota Medical School , Minneapolis, MN, USA MD Roles: Professor of Surgery Find this author on Google Scholar Find this author on PubMed Search for this author on this site Nicholas Cozzi 17 Rush University Medical Center , Chicago, IL, USA MD, MBA, FACEP, FAEMS Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kimberly A. Davis 18 Division Chief, General Surgery, Trauma and Surgical Critical Care Yale School of Medicine Department of Surgery , New Haven, CT, USA MD, MBA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Rochelle A. Dicker 19 UCSF, San Francisco , CA, USA MD Roles: Professor of Surgery Find this author on Google Scholar Find this author on PubMed Search for this author on this site Warren C. Dorlac 20 Vice Chair, COT University of Colorado, Associate Trauma Medical Director, Medical Center of the Rockies , Loveland, CO, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Erik Van Eaton 21 Department of Surgery, University of Washington , Seattle, WA, USA MD Roles: Associate Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Evert Eriksson 22 Medical University of South Carolina, Department of Surgery , Charleston, SC, USA MD Roles: Professor of Surgery Find this author on Google Scholar Find this author on PubMed Search for this author on this site Susan Evans 23 Wake Forest School of Medicine, Vice Chair Research, Department of Surgery , Winston-Salem, NC, USA Atrium Health MD, MBA Roles: Professor of Surgery Find this author on Google Scholar Find this author on PubMed Search for this author on this site Shannon Marie Foster 24 Acute Care Surgeon Contractor Director, SMF Coverage & Solutions LLC , Reading, PA, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jeffrey M. Goodloe 25 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 MD Roles: Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Elliott R. Haut 26 Johns Hopkins University School of Medicine ; Baltimore, MD, USA MD, PhD Roles: Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Molly Jarman 27 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 PhD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Alyssa Johnson 28 Montana Trauma System Manager, Dept. of Public Health & Human Services , Helena, MT, USA MSN, RN, TCRN, CEN Find this author on Google Scholar Find this author on PubMed Search for this author on this site Meera Kotagal 29 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 MD, MPH Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Morgan Krause 30 Trauma Nurse Research Coordinator, Northeast Georgia Medical Center , Gainesville, GA, USA MSN-Ed Find this author on Google Scholar Find this author on PubMed Search for this author on this site John C. Kubasiak 31 Assistant Professor of Surgery, Loyola University Chicago , Maywood, IL, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kelly Lang 32 Author, Speaker, Advocate, The Miracle Child ; Leesburg, VA, USA BA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Allison Barbara Leigh 33 University of Colorado School of Medicine’s Fort Collins Branch , Aurora, CO, USA MD candidate Roles: Medical Student Find this author on Google Scholar Find this author on PubMed Search for this author on this site Halinder S. Mangat 34 Associate Professor, Kansas University Medical Center, Kansas City, KS, USA Director of Research , Brain Trauma Foundation, Palo Alto, CA, USA MD, MSc Find this author on Google Scholar Find this author on PubMed Search for this author on this site Debra Marie Marvel 35 Patient Representative, R Adams Cowley Shock Trauma Center , Baltimore, MD, USA Patient Advocate CNTR, San Antonio, Texas MA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Christopher Paul Michetti 36 Chief of Trauma, Professor of Surgery, University of Maryland Capital Region Medical Center, Department of Surgery , Largo, MD, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Vicki Moran 37 Associate Professor of Nursing, Saint Louis University; St. Louis, MO, USA Trauma Research Coordinator, SSM Health Saint Louis University Hospital , MO, USA PhD, RN Find this author on Google Scholar Find this author on PubMed Search for this author on this site Ashley N. Moreno 38 Coalition for National Trauma Research; San Antonio , TX, USA MS Roles: Research Associate Find this author on Google Scholar Find this author on PubMed Search for this author on this site Simon JW Oczkowski 39 Department of Medicine, Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton, Canada MD, MSc, MHSc Roles: Associate Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Michael A. Person 40 University of South Dakota ; Sioux Falls, SD, USA MD, MPH Roles: Associate Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site Michelle A. Price 41 Executive Director, Coalition for National Trauma Research; San Antonio, TX, USA Adjunct Professor , UT Health San Antonio, TX, USA PhD, Med Find this author on Google Scholar Find this author on PubMed Search for this author on this site LJ Punch 42 Medical Director, The Bullet Related Injury Clinic , St. Louis, MO, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Megan Racey 43 Research Coordinator, McMaster University , Hamilton, Ontario, Canada PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Bradford L. Ray 44 Director. Patient Blood Management & Research University Medical Center, El Paso, Texas, USA Clinical Instructor , Trauma, General Surgery El Paso, Texas, USA CCP, RABT Find this author on Google Scholar Find this author on PubMed Search for this author on this site Diane Redmond 45 Trauma-Clinical Research Nurse, Penrose Hospital, Trauma Services , Colorado Springs, CO, USA MSN, RN, TCRN, CPHQ, CCRP Find this author on Google Scholar Find this author on PubMed Search for this author on this site Linda Kate Reinhart 46 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 MSN, CNS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Heather Rhodes 47 Trauma Scientist, Center for Clinical Epidemiology and Population Health , Marshfield, WI, USA PhD, DHS, RT(R)(ARRT)CT Find this author on Google Scholar Find this author on PubMed Search for this author on this site Bryn Rhodes 48 Director of Standards Strategy, Smile Digital Health , Toronto, ON, USA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Andres M. Rubiano 49 Professor of Neurosciences and Neurosurgery Universidad El Bosque, Bogota, Colombia Medical and Research Director, Meditech Foundation , Cali, Colombia MD, PhD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Sabrina Sanchez 50 Associate Professor of Surgery, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA Attending Surgeon, Boston Medical Center , Boston, MA, USA MD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Babak Sarani 51 Professor of Surgery and Emergency Medicine George Washington University , Washington, DC, USA MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Erica Shelton 52 Department of Emergency Medicine, Johns Hopkins University ; Baltimore, MD, USA MD, MPH, MHS Roles: Assistant Professor Find this author on Google Scholar Find this author on PubMed Search for this author on this site David A Spain 53 Stanford University , Stanford, CA, USA MD Roles: Professor of Surgery Find this author on Google Scholar Find this author on PubMed Search for this author on this site Kristan Staudenmayer 54 Associate Professor of Surgery Stanford University , Stanford, CA, USA Chair, ACS COT Trauma Systems, COT, Chicago, IL MD, MS Find this author on Google Scholar Find this author on PubMed Search for this author on this site Deborah M. Stein 55 Professor of Surgery, University of Maryland School of Medicine Program in Trauma , Baltimore, MD, USA MD, MPH Find this author on Google Scholar Find this author on PubMed Search for this author on this site Julie Valenzuela 56 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 MD Find this author on Google Scholar Find this author on PubMed Search for this author on this site Cynthia Lizette Villarreal 57 Director of Applied Research, Coalition for National Trauma Research; San Antonio , TX, USA MA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Jeffrey L. Wells 58 Non-Scientist IRB Member Univ. MD, Baltimore, USA Non-Scientist IRB Member NIH Bethesda, MD, USA AA Find this author on Google Scholar Find this author on PubMed Search for this author on this site Gabriela Zavala Wong 59 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 MD Roles: Research Scientist Find this author on Google Scholar Find this author on PubMed Search for this author on this site For correspondence: gabriela.zavalawong{at}uchealth.org gabrielazavalaw{at}gmail.com LeAnne Sitari Young 60 Assistant Clinical Director of Trauma and Injury Prevention Texas Children’s Hospital, Trauma Services , Houston, TX Immediate Past President, Society of Trauma Nurses MSN, RN, TCRN Find this author on Google Scholar Find this author on PubMed Search for this author on this site Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Introduction Representatives of the trauma community have voiced a need for a new approach to developing clinical guidance. In this study, we test the initial acceptability of a proposed 12-step approach that aims to reduce the current clinical guidance timeline from more than 24 months to 24 weeks. Methods Investigators hypothesized that artificial intelligence (AI) tools could be leveraged to improve and make the process of clinical guidance development more efficient, facilitating AI initial output that could later be reviewed by subject matter experts (SMEs). Ensuring ethical standards and a collaborative design. Following the agile methodology, emphasizing continuous delivery and improvement, and the Practical, Robust Implementation and Sustainability Model (PRISM) framework, the investigators drafted a 12-step approach to clinical guidance development in 24 weeks. The process starts with the selection of a clinical topic and culminates in a bedside-ready clinical decision tree. Results The 2025 Design for Implementation: The Future of Trauma Research & Clinical Guidance conference participants were invited to reflect on this new 12-step approach during two breakout sessions. Participants included a broad range of trauma providers, methodologists, patient representatives, technology, and marketing experts. Their recommendations highlighted: 1) multidisciplinary involvement, 2) need for resource-stratified recommendations, and 3) user-friendly features (offline and multilingual access). On a post conference survey (n=56), 64% were confident in AI accelerating the current development process. Conclusions The current landscape of clinical guidance offers significant opportunities for improvement. Key areas for enhancement include promoting collaboration across multiple disciplines and organizations, developing recommendations that consider resource variations, and utilizing new technologies, such as AI, to expedite the development process. This is crucial because ongoing delays lead to practices lagging behind current evidence. Further research is needed to rigorously test and refine how responsible use of AI can be integrated into expediting evidence integration into clinical guidance. What is already known on this topic Current clinical guidance typically takes 1-2 years to develop. Moreover, clinical guidance may not be published until a year or more after its completion, long after some recommendations become outdated, contributing to lagged evidence-informed practice. What this study adds This study shares and tests the initial acceptability of a novel approach that aims to reduce the current clinical guidance timeline from 24 months to 24 weeks. It leverages existing artificial intelligence tools but with the critical input of subject matter experts (SMEs), ensuring ethical standards and collaborative design. SMEs shed light on critical steps and key areas that future clinical guidance needs to consider. How this study might affect research, practice or policy The current landscape of clinical guidance offers significant opportunities for improvement. Key areas for enhancement include promoting collaboration across multiple disciplines and organizations, developing recommendations that consider resource variations, and utilizing new technologies, such as artificial intelligence, to expedite the development process. INTRODUCTION Clinical guidance is the cornerstone of evidence-informed practice, promoting recommendations that aid clinical decision making and reduce harmful, ineffective practices. [ 1 ] Nonetheless, there is still an existing gap between what we know and what we practice due to implementation barriers that are often ignored, including suboptimal healthcare networks, time constraints, poor applicability to real-world clinical practice, lack of equipment, and human resources. [ 2 – 3 ] These barriers make clinical guidance impractical and inapplicable to several settings failing to fulfill its purpose: supporting consistent quality clinical care. [ 4 ] Studies have documented this challenge across multiple regions and clinical specialties. For instance, a 2016 systematic review and meta-analysis reported a global decrease in adherence rates to venous thromboembolism prophylaxis guidance. [ 5 ] Another review on World Health Organization’s Guidelines for Essential Trauma Care, found that less than 30% of the world had implemented these guidelines to any extent. [ 6 ] While numerous resources have been developed, their content fails to account for predictable, already identified implementation barriers. Implementation matters because as Rice et al. described in 2012, a major deviation in the standard of care for injured patients resulted in a threefold increase in 30- and 90-day mortality. [ 7 ] Similar results were found in Godier et al (2016), where clinical guidance compliance resulted in decreased mortality at 24 hours and 30 days. [ 8 ] Furthermore, a 2024 assessment of 20 trauma clinical guidance found most of them do not consider usability aspects and lack of patient-friendly resources. [ 9 ] It is estimated that it takes an average of 17 years for 14% of evidence [ 10 ] to reach clinical practice. Furthermore, clinical guidance may not be published until a year or more after its completion, long after the publication date of most of the studies included in the clinical guidance. [ 11 ] By its publication date, newer studies or interventions may have occurred, and some recommendations will have become outdated; therefore, even if providers are following current clinical guidance, there are still knowledge gaps and a lag in evidence-informed practice. [ 12 ] Traumatic injuries, one of the leading causes of death in the United States, are among the major health categories that suffer from the chaotic landscape of clinical guidance development. A 2024 systematic review found that most trauma clinical guidance is developed for and by high-income settings.[ 13 ] Thus, multiple organizations are currently making the effort to build more accessible, evidence-informed clinical guidance for trauma care to aid clinical decision making in austere environments where surgical workforce density and skillsets are sometimes insufficient to meet the demands safely. [ 14 – 16 ] External evidence is better adapted when it’s conducted in a collaborative environment that considers the variability of resources available and values local experts. [ 17 ] However, this remains a global problem, and even the most well-resourced health systems can become resource constrained due to natural disasters, civil conflicts, or technology outages. Clinical guidance adaptation frameworks provide a step-by-step approach to implement existing clinical guidance into a specific local context. Several frameworks exist, including the Practice Guidelines Evaluation and Adaptation Cycle (PGEAC) [ 18 ], Systematic Guideline Review (SGR) [ 19 ], ADAPTE [ 20 ], The Alberta Ambassador Program (AAP) adaptation process [ 21 ], CAN-IMPLEMENT [ 22 ], SNAP-IT by GRADE (MAGIC) [ 23 ], Adapted ADAPTE [ 24 ], Appraisal of Guidelines for Research & Evaluation II (AGREE-II) [ 25 ], and GRADE-ADOLOPMENT. [ 26 ] Nonetheless, there are still gaps in the impact of clinical guidance adaptation and therefore implementation, especially in low-resource settings and low- and middle-income countries (LMICs). Harrison et al. (2013) found that it sometimes takes more than 24 months to complete the clinical guidance adaptation process. This process did not represent a faster approach than clinical guidance creation, 1-2 years. [ 27 ] Representatives of the trauma community are voicing a need for a new approach and proposing strategies that focus on professional society collaboration, designing primary clinical research for implementation, a systematic prioritization of selected clinical topics for clinical guidance development, enhancing transparent authorship representation, planning for regular review and revision of clinical guidance, improving discoverability of clinical guidance, optimizing user experience, disseminating clinical guidance, and utilization of open access and open licenses. [ 28 – 31 ] Today’s trauma care is already changing with the inclusion of artificial intelligence (AI) in healthcare. Machine learning and large language models (LLMs) are aiding healthcare practitioners with suggested therapeutics embedded in electronic health records (EHRs) [ 32 ], enhanced imaging diagnostics [ 33 ], patient monitoring [ 34 ], medical device automation [ 35 ], transcription of provider-patient encounters [ 36 ], and much more. Inspired by the needs of the trauma community and given the emerging innovations in AI, we hypothesize that AI can be leveraged, following ethical standards, to improve the current process of clinical guidance development while considering resource variability when providing evidence-informed recommendations. Thus, reducing the current timeline for clinical guidance development to 24 weeks, from topic selection to a bedside-ready clinical decision tree. This manuscript reflects the initial acceptability testing of this hypothesized approach with subject matter experts (SMEs) during the 2025 Design for Implementation: The Future of Trauma Research & Clinical Guidance (DFI) conference. METHODS The 12-Step Approach for Clinical Guidance Development Based on previous findings [ 13 , 30 – 31 ], following the agile methodology [ 37 ], emphasizing continuous delivery and improvement, and the Practical, Robust Implementation and Sustainability Model (PRISM) framework [ 38 ] to scale and improve current clinical guidance development process, participants were presented with a 12-step approach ( Table 1 ) to clinical guidance development. View this table: View inline View popup Table 1: 12-step approach for clinical guidance development Setting and Participants To obtain feedback and gather reflections from SMEs, we engaged key partners (i.e., trauma providers, professional society leadership, methodological experts, patient representatives, technology experts, and marketing experts) during the second annual DFI conference that occurred February 19-20, 2025, in Chicago, Illinois, USA. Convenience snowball sampling was employed for recruiting in-person participants. This study was reviewed by the Colorado Multiple Institutional Review Board, CB F490; COMIRB No: 24-1608 and COMIRB #: 22-0626 and determined exempt from institutional review board review. Seventy people participated in-person, and up to 55 virtual participants attended via Zoom. Conference Structure and Activities Conference attendees participated in two breakout sessions where each one of the 12 steps was explained, and they were invited to provide low-fidelity process feedback through a set of questions relating to each step (see Supplemental Item 1). The objective of these sessions was to reflect on the approach to a combined synchronous/asynchronous, AI-accelerated, SME-informed, evidence synthesis expert and ethicists-regulated process to the development of resource-relevant clinical guidance with a beside-side ready decision tree. Participants provided their responses either verbally or via an anonymous polling platform (Slido; https://www.slido.com/ ). In a semi-structured focus group format, follow-up questions were conducted when participants raised concerns and shared improvement strategies to improve portions of this proposed 12-step process. After these two breakout groups concluded, an additional subgroup of nine SMEs was selected to pilot test this new strategy. The nine participants within the SME subgroup were selected based on their research, experience with, and high involvement in, clinical guidance development. Efforts were taken to ensure this group contained adequate representation of patient advocates, physicians, nurses, and methodological experts – simulating the recommended approach for real-world development of clinical guidance. Participants were then presented with a draft algorithm which had been developed using out-of-the-box AI tools. For piloting, the volume resuscitation portion of a damage control resuscitation algorithm was selected. [ 39 ] This was chosen for recency of publication, and representativeness of a national trauma collaboration. The full-text references from this algorithm were then loaded into Chat Generative Pre-Trained Transformer (GPT)-4 Plus and a query written to prompt Chat-GPT to draft a clinical algorithm. The output was reviewed and query revised until the algorithm drafted presented content of basic clinical utility and accuracy. In sequence, prompts requested Chat-GPT to summarize references, create bullet-point recommendations, and convert them into a clinical decision tree. This AI-generated volume resuscitation clinical decision tree was presented in an interactive platform (Miro; www.miro.com/app ) to allow for live-editing and integration of user-feedback. SMEs were first asked to review asynchronously, using mobile survey tooling to either agree with each node of the presented algorithm, or suggest modification. Then, facilitators took the group through the results of the asynchronous polling and the narrative text of the suggested modifications. Post-Conference Survey Finally, an anonymous post-conference survey was administered to all participants via Microsoft Forms (Microsoft Corporation, 2024) to capture final thoughts on this new 12-step approach to clinical guidance creation and the future of clinical guidance development through Likert-scale questions. Data Analysis SME breakout sessions feedback was captured via an anonymous polling platform, Slido ( https://www.slido.com/ ). Through inductive coding, SMEs’ reflections were grouped into thematic categories. These included: Patient Advocacy, Workgroup Selection, Project Management, Workload Organization, Dissemination and Implementation Science, Funding Opportunities, Information and Technology, Diverse Language, AI Ethical Standards, Expert Opinion, Aligned Incentives, Accountability Resource Variability, Consensus Methodology, Quantity Cut-Off of Consensus and Mutual Understanding of Consensus Disagreement and National Incentives. Participants’ quotes were included for better representation of each category. SME subgroup voting and comments were also gathered via Slido. Their voting results were expressed as percentages, to facilitate interpretation and identification of consensus areas among respondents. When SMEs disagreed with one of the recommendations included in the clinical decision tree, they were encouraged to submit their modification request via Slido as a comment. These underwent inductive coding and were grouped into the following thematic categories: Patient Advocacy, Accountability for Resource Variability, Need for Detailed Recommendations, Accountability for Different Populations and Format. Post-conference survey results were presented using descriptive statistics. RESULTS Perspectives of the 12-step Approach Seventy in-person, and up to 55 virtual participants included a broad range of SMEs, including trauma providers, professional societies leadership, methodological experts, patient representatives, and technology and marketing experts. When the 12-step approach was presented during two breakout sessions, SMEs provided their input, and not all steps triggered observations or comments ( Table 2 ). SMEs expressed the desire to include more patients and patient advocates; assured diverse representation across healthcare providers and practice settings (e.g., low-, middle- and high-resource settings; rural and urban) and shared concerns with lack of engagement and time constraints. They also highlighted the need for more user-friendly features like offline content availability, mobile app-based medical information, information in more languages, and open-access information. They agreed about the importance of reviewing AI-augmented steps and following implementation and dissemination strategies to achieve sustainability. View this table: View inline View popup Table 2. SMEs Breakout Sessions Reflecting on 12-Step Approach During the pilot test of a preliminary algorithm ( Figure 1 ) for volume resuscitation created using AI augmentation with the smaller, nine person subgroup of SMEs (one patient advocate, three methodological experts and five trauma providers), participant feedback highlighted once again the need to include additional decision tree nodes (pathways) that reflected resource variability, equipment, and trained personnel, suggested more specific recommendations and more information about treatment options (e.g., range, age, when, how and what to monitor, inclusion criteria, comorbidities and lab values), the inclusion of additional population thresholds, and advised on formatting and avoiding repetitive or redundant recommendations and connectors (see Table 3 and Figure 2 ). Most recommendations had less than 60% of agreement. Blood pressure parameters were the only recommendations that had 100% agreement; the recommendations that triggered less agreement (22%) were found to be redundant or had missing information. Download figure Open in new tab Figure 1. AI-augmented volume resuscitation algorithm Download figure Open in new tab Figure 2. AI-augmented volume resuscitation algorithm incorporating SME’s feedback View this table: View inline View popup Table 3: SME’s pilot test AI-augmented algorithm Post-Conference Survey In a final reflection, 56 participants provided their thoughts on the future of clinical guidance development via the post-conference survey. Seventy-nine percent (n=44) of respondents believed that the current status quo of clinical decision making leaves room for improvement. Despite the algorithm being a beta, very preliminary prototype of what the future of clinical guidance could be, 64% of respondents were confident that AI can be useful synthesizing complex clinical guidance to increase translation of evidence into practice. Finally, more than 70% of participants rated user-friendliness, graphics, ability to personalize settings, relevance, and ethical considerations as important factors for a bedside-ready clinical guidance tool. DISCUSSION The research team proposed a 12-step approach to improve the current status of clinical guidance development, leveraging LLMs and existing AI to reduce the current burden SMEs experience with today’s approach. Nonetheless, the value of SMEs’ input as irreplaceable was highlighted, and having AI-augmented steps requires setting standards and regulatory reviews to ensure quality throughout the development process. After reviewing this new approach with SMEs during the conference, the importance of ensuring adequate representation (e.g. rural, urban, high-, medium- and low-resource settings), multidisciplinary groups of healthcare providers and scientists, patient advocates, muti-system/multi-organizational coordination, and a standardized framework to follow was essential. SMEs’ concerns revolved around lack of time, lack of funding, sustainability, project coordination and management, adaptability to reflect resource variability, and implementation and dissemination of the developed products. When a subgroup of SMEs tested a very preliminary AI-augmented clinical decision tree on volume resuscitation, their review became more granular in terms of content, wording, and formatting; however, the critical need to include resource variability within the clinical decision support was again highlighted. As previously discussed, the current clinical guidance development is far from ideal, and today’s clinical practice has a more than 10-year gap [ 8 ]; additionally, the time invested in clinical guidance development is between 1-2 years. [ 11 , 40 ] Prioritizing the improvement of this process is imperative as clinical decision making benefits from consistent, quality care through clinical guidance. Further, the current timeline fails to scale when a pandemic, socio-political conflict, or natural disaster demands clinical decision support that considers resource variability and the unknown nature of a new disease. Some organizations have started to collaborate and join in efforts for a more practical way to develop clinical guidance. The British Medical Journal (BMJ), Australian Living Evidence Collaboration, World Health Organization (WHO), and Stroke Foundation have partnered with MAGIC Evidence Ecosystem Foundation to develop rapid, trustworthy recommendations to improve the delivery of quality care. [ 41 ] An example is the BMJ Rapid Recommendation on Low Intensity Pulsed Ultrasound (LIPUS) for fracture healing. [ 42 ] Advances in evidence synthesis and technology are promising for the future of clinical guidance. Khraisha et al. (2024) evaluated the performance of GPT-4, one of the biggest LLMs on the market, on title/abstract screening, full-text review, and data extraction across various literature types and languages. Results were variable in screening and data extraction; however, with screening full-text literature, its performance reached “human-like” levels. [ 43 ] Our proposed approach builds on LLMs, accelerating the process in a structured manner that ensures regulatory oversight and SME governance to deliver quality and accountability. Finally, SMEs, in line with current literature, voiced that clinical guidance development requires multidisciplinary partnerships to guarantee the creation of relevant recommendations that are rigorous and high quality. A cross-disciplinary approach harnesses a variety of contexts (diverse populations, cultures, healthcare systems) to create more applicable, adaptable, and implementable clinical guidance. [ 44 – 45 ] Guidelines International Network (GIN) exemplifies the collaboration efforts of 93 organizations and 89 individuals representing 46 countries that aim to set international standards for clinical guidance development. [ 45 ] Limitations Most of the participants came from urban, academic, and high-resource backgrounds. Although virtual participation was intentionally open and not restricted to such environments, representation from rural, low-resources, community-based settings was unbalanced; and, therefore, could be a potential bias when capturing SMEs perspectives. To mitigate this, when piloting the AI-augmented algorithm, the research team selected a more balanced representation of SMEs, taking into consideration urban, rural, academic, and non-academic experts. It is also recognized that the sample size was small overall and results reflect low-fidelity feedback. In addition, integration and use of AI in clinical guidance development remains in early stages, and requires further refinement, validation, and standardization. While the proposed approach aims to incorporate resource variability, the research team recognizes that it is not fully limited to trained personnel or infrastructure constraints but encompasses healthcare norms and system-level practices that could differ significantly across countries. These factors were not explicitly addressed in this initial model. CONCLUSION The current landscape of clinical guidance offers significant opportunities for improvement. Key areas for enhancement include promoting collaboration across multiple disciplines and organizations, developing recommendations that consider variations in resources, and utilizing innovative technologies, such as AI, to expedite the development process. This is crucial because ongoing delays lead to lagged evidence-informed practice. New approaches, including the one herein proposed, to creating clinical guidance merit further research to assess and refine models rigorously. Such efforts would enhance consistency, relevance, implementability, and timeliness of the clinical guidance, ultimately improving care across various settings. SUPPLEMENTAL ITEMS Supplemental Item 1. Breakout Session Slides Data Availability A limited, deidentified subset of data produced in the present study are available upon reasonable request to the authors. Footnotes Disclosure of Artificial Intelligence (AI): This manuscript includes a clinical decision tree that is not intended to provide any medical advice. It is rather a proof of concept for research purposes only. This clinical decision tree was created with the help of Chat Generative Pre-Trained Transformer (GPT)-4 Plus. Refences from the American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma: Clinical Protocol for Damage-Control Resuscitation for the Adult Trauma Patient were uploaded to this artificial intelligence (AI) tool, prompts were generated and entered by one of the authors (GZW) and the output was reviewed by two authors (GZW, LNL) until the AI tool assisted drafting a clinical decision tree that was considered ready to be shared with the study population. Prompts requested Chat-GPT to summarize references, create bullet-point recommendations, and convert them into a clinical decision tree (algorithm). HUMAN SUBJECTS STATEMENT: This study was reviewed by the Colorado Multiple Institutional Review Board, CB F490; COMIRB No: 24-1608 and COMIRB #: 22-0626, and determined exempt from institutional review board review. FUNDING STATEMENT: The Design for Implementation: The Future of Trauma Research & Clinical Guidance (DFI) conference series was made possible, in part, by a conference grant from the Agency for Healthcare Research and Quality (1R13HS028940-01A1). 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. The American Association for the Surgery of Trauma, American Burn Association, American Trauma Society, Eastern Association for the Surgery of Trauma, Chest Wall Injury Society, Society of Critical Care Medicine, Society of Trauma Nurses, and Trauma Center Association of America provided travel funds for representatives to attend the 2025 DFI meeting. The Eastern Association for the Surgery of Trauma and American Trauma Society provided travel funds for patient partners to attend. The Society of Trauma Nurses, Acera Surgical, and Tactuum provided additional financial support. The American College of Surgeons hosted the event in its Chicago offices and provided meeting management, facilities, and audiovisual equipment at no cost to the conference. Publication of this supplement is made possible by Medical Center of the Rockies, UCHealth (Loveland, Colorado, United States). CONFLICTS OF INTEREST: Katheryn Grider, Gabriela Zavala Wong, Megan Racey, Diana Sherifali, 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 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, 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 a consultant for Credence Management Solutions. Jeffrey L. 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