Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need
Introduction: Globally, trauma patients suffer from high rates of preventable deaths, in part driven by low rates of access to and application of resource-relevant evidence-informed clinical guidance. This mixed-methods study assessed the accessibility (barriers to attempting to use guidance), clari...
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2026
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| author | Anika Srinath E J Lee Gianni Aragon Giuliano Borda‐Luque Gabriela Zavala Wong Ana Lucia Carranza Eduardo Huaman Andrea Olabarrera Manuel J Rodríguez Kirsten Senturia Lucas Távara Wiess Lacey N. LaGrone |
| author_browse | Ana Lucia Carranza Andrea Olabarrera Anika Srinath E J Lee Eduardo Huaman Gabriela Zavala Wong Gianni Aragon Giuliano Borda‐Luque Kirsten Senturia Lacey N. LaGrone Lucas Távara Wiess Manuel J Rodríguez |
| author_facet | Anika Srinath E J Lee Gianni Aragon Giuliano Borda‐Luque Gabriela Zavala Wong Ana Lucia Carranza Eduardo Huaman Andrea Olabarrera Manuel J Rodríguez Kirsten Senturia Lucas Távara Wiess Lacey N. LaGrone |
| author_sort | Anika Srinath |
| collection | Producción científica |
| description | Introduction: Globally, trauma patients suffer from high rates of preventable deaths, in part driven by low rates of access to and application of resource-relevant evidence-informed clinical guidance. This mixed-methods study assessed the accessibility (barriers to attempting to use guidance), clarity (ease of comprehension), utility (based on resources and time), and implementation of trauma guidance for Peruvian injury providers. Methods: Semistructured qualitative interviews were conducted in Spanish at three hospitals in Lima, Peru. Interviews were analyzed in Dedoose V.9.1.12 using an iteratively developed codebook; quantitative self-administered surveys were then developed and distributed at the Pan American Trauma Society Conference. Surveys were analyzed using descriptive statistics and frequencies. Results: 38 interviews and 83 surveys were conducted with surgical attendings, emergency physicians, and surgical and emergency residents across all years of training. Access barriers included paywalls, language barriers, low user-friendliness, and technology limits (poor internet, few computers). A mobile app and portable physical guidance are preferred potential solutions. Utility barriers included low equipment maintenance and high patient volumes. Resource-based guidance, conciseness (eg, flowcharts), and standardization are perceived to potentially increase utility. Implementation barriers included limited training time, reliance on more experienced colleagues rather than guidance, low enforcement, and low funding. Potential facilitators are increased administrative support and staff willingness to use guidance improving patient mortality, clinical errors, and length of stay. No barriers to clarity were reported. Conclusion: Barriers to using clinical guidance included low user-friendliness, low local applicability, and an unsupportive culture. Mobile apps, resource stratification, and administrative involvement are priorities to address these needs. Trauma guidance adapted to local realities may reduce preventable deaths in acute care. Further work is needed to identify how to create and distribute updated clinical guidance to better serve trauma providers worldwide. Level of evidence: Economic and Value-based Evaluations Level 2. |
| format | Article |
| id | oai:cris.upeu.edu.pe:20.500.15037/1343 |
| institution | UPeU |
| language | English |
| publishDate | 2026 |
| publishDateRange | 2026 |
| publishDateSort | 2026 |
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| spelling | oai:cris.upeu.edu.pe:20.500.15037/13432026-10-30T16:15:37ZPhysician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in needAnika SrinathE J LeeGianni AragonGiuliano Borda‐LuqueGabriela Zavala WongAna Lucia CarranzaEduardo HuamanAndrea OlabarreraManuel J RodríguezKirsten SenturiaLucas Távara WiessLacey N. LaGroneCLARITYMedicineStandardizationQualitative researchMedical emergencyNursingHuman factors and ergonomicsDescriptive statisticsResource (disambiguation)Suicide preventionOccupational safety and healthMEDLINEPoison controlPatient safetyNeeds assessmentMedical educationInjury preventionTriageFamily medicineEmergency departmentLanguage barrierQualitative analysisAdvanced trauma life supportComputer-assisted web interviewingMobile deviceClinical decision makingMobile appsQualitative propertyFocus groupCLARITYStandardizationQualitative researchHuman factors and ergonomicsDescriptive statisticsResource (disambiguation)Suicide preventionOccupational safety and healthMEDLINEHealth Sciences Health Professions Emergency Medical Services Patient Safety and Medication ErrorsHealth Sciences Medicine Emergency Medicine Trauma and Emergency Care StudiesHealth Sciences Medicine Emergency Medicine Emergency and Acute Care StudiesIntroduction: Globally, trauma patients suffer from high rates of preventable deaths, in part driven by low rates of access to and application of resource-relevant evidence-informed clinical guidance. This mixed-methods study assessed the accessibility (barriers to attempting to use guidance), clarity (ease of comprehension), utility (based on resources and time), and implementation of trauma guidance for Peruvian injury providers. Methods: Semistructured qualitative interviews were conducted in Spanish at three hospitals in Lima, Peru. Interviews were analyzed in Dedoose V.9.1.12 using an iteratively developed codebook; quantitative self-administered surveys were then developed and distributed at the Pan American Trauma Society Conference. Surveys were analyzed using descriptive statistics and frequencies. Results: 38 interviews and 83 surveys were conducted with surgical attendings, emergency physicians, and surgical and emergency residents across all years of training. Access barriers included paywalls, language barriers, low user-friendliness, and technology limits (poor internet, few computers). A mobile app and portable physical guidance are preferred potential solutions. Utility barriers included low equipment maintenance and high patient volumes. Resource-based guidance, conciseness (eg, flowcharts), and standardization are perceived to potentially increase utility. Implementation barriers included limited training time, reliance on more experienced colleagues rather than guidance, low enforcement, and low funding. Potential facilitators are increased administrative support and staff willingness to use guidance improving patient mortality, clinical errors, and length of stay. No barriers to clarity were reported. Conclusion: Barriers to using clinical guidance included low user-friendliness, low local applicability, and an unsupportive culture. Mobile apps, resource stratification, and administrative involvement are priorities to address these needs. Trauma guidance adapted to local realities may reduce preventable deaths in acute care. Further work is needed to identify how to create and distribute updated clinical guidance to better serve trauma providers worldwide. Level of evidence: Economic and Value-based Evaluations Level 2.Articlehttps://pubmed.ncbi.nlm.nih.gov/41810415https://tsaco.bmj.com/content/11/1/e001924.full.pdfhttps://doi.org/10.1136/tsaco-2025-00192410.1136/tsaco-2025-001924https://hdl.handle.net/20.500.15037/1343W7134044968enTrauma Surgery & Acute Care Open2397-57762026-01-012026-06-13T09:54:04Z2026-06-13T09:54:04Z |
| spellingShingle | CLARITY Medicine Standardization Qualitative research Medical emergency Nursing Human factors and ergonomics Descriptive statistics Resource (disambiguation) Suicide prevention Occupational safety and health MEDLINE Poison control Patient safety Needs assessment Medical education Injury prevention Triage Family medicine Emergency department Language barrier Qualitative analysis Advanced trauma life support Computer-assisted web interviewing Mobile device Clinical decision making Mobile apps Qualitative property Focus group CLARITY Standardization Qualitative research Human factors and ergonomics Descriptive statistics Resource (disambiguation) Suicide prevention Occupational safety and health MEDLINE Health Sciences Health Professions Emergency Medical Services Patient Safety and Medication Errors Health Sciences Medicine Emergency Medicine Trauma and Emergency Care Studies Health Sciences Medicine Emergency Medicine Emergency and Acute Care Studies Anika Srinath E J Lee Gianni Aragon Giuliano Borda‐Luque Gabriela Zavala Wong Ana Lucia Carranza Eduardo Huaman Andrea Olabarrera Manuel J Rodríguez Kirsten Senturia Lucas Távara Wiess Lacey N. LaGrone Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need |
| title | Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need |
| title_full | Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need |
| title_fullStr | Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need |
| title_full_unstemmed | Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need |
| title_short | Physician experiences with clinical uncertainty in the trauma setting: making clinical guidance accessible to those in need |
| title_sort | physician experiences with clinical uncertainty in the trauma setting making clinical guidance accessible to those in need |
| topic | CLARITY Medicine Standardization Qualitative research Medical emergency Nursing Human factors and ergonomics Descriptive statistics Resource (disambiguation) Suicide prevention Occupational safety and health MEDLINE Poison control Patient safety Needs assessment Medical education Injury prevention Triage Family medicine Emergency department Language barrier Qualitative analysis Advanced trauma life support Computer-assisted web interviewing Mobile device Clinical decision making Mobile apps Qualitative property Focus group CLARITY Standardization Qualitative research Human factors and ergonomics Descriptive statistics Resource (disambiguation) Suicide prevention Occupational safety and health MEDLINE Health Sciences Health Professions Emergency Medical Services Patient Safety and Medication Errors Health Sciences Medicine Emergency Medicine Trauma and Emergency Care Studies Health Sciences Medicine Emergency Medicine Emergency and Acute Care Studies |
| topic_facet | CLARITY Medicine Standardization Qualitative research Medical emergency Nursing Human factors and ergonomics Descriptive statistics Resource (disambiguation) Suicide prevention Occupational safety and health MEDLINE Poison control Patient safety Needs assessment Medical education Injury prevention Triage Family medicine Emergency department Language barrier Qualitative analysis Advanced trauma life support Computer-assisted web interviewing Mobile device Clinical decision making Mobile apps Qualitative property Focus group CLARITY Standardization Qualitative research Human factors and ergonomics Descriptive statistics Resource (disambiguation) Suicide prevention Occupational safety and health MEDLINE Health Sciences Health Professions Emergency Medical Services Patient Safety and Medication Errors Health Sciences Medicine Emergency Medicine Trauma and Emergency Care Studies Health Sciences Medicine Emergency Medicine Emergency and Acute Care Studies |
| url | https://pubmed.ncbi.nlm.nih.gov/41810415 https://tsaco.bmj.com/content/11/1/e001924.full.pdf https://doi.org/10.1136/tsaco-2025-001924 https://hdl.handle.net/20.500.15037/1343 |
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