Exploring Provider Perspectives on Gaps in Trauma-Informed Care Delivery Within the Acute Care Surgery Timeline: a Human Centered Design Study at a Federally Qualified Health Center (Preprint)

BACKGROUND Trauma-informed care (TIC) education plays a pivotal role in preparing physicians to deliver care to patients who have experienced emotional and physical trauma, empowering patients to have agency in their care. The delivery of TIC by providers is especially important at Federally Qualified Health Centers (FQHC), as their patients disproportionately experience trauma due to the impacts of socioeconomic determinants of health including limited healthcare access, systemic racism, and housing insecurity. There is limited literature about how to adapt TIC practices in acute care settings, specifically for emergency medicine and surgical providers who deliver care in high-demand, time-constrained environments. OBJECTIVE The goal of this study was to understand the barriers and enablers to the delivery of TIC for patients in acute care settings at an urban safety net hospital. METHODS This exploratory qualitative study applied methods from the first stage of the Human-Centered Design process, known as the Inspiration Phase, to identify the factors that influence providers’ decisions to provide or not provide TIC within the acute care ecosystem. In this Inspiration Phase, we conducted 18 semi-structured interviews with providers delivering surgical care at an FQHC in Northern California. Interviewees were purposefully sampled to represent the diversity of providers involved throughout the perioperative timeline, including physicians, nurses, social workers, psychologists, and de-escalation staff. Inductive thematic analysis of transcripts and subsequent insight statement generation was conducted to identify tensions between stakeholder needs and to elucidate design opportunities to improve their ability to deliver TIC. RESULTS Inductive analysis identified 24 unique themes and 7 insights that impact the effective implementation of TIC by providers in acute care settings. Time-constrained workflows, vicarious trauma, and provider burnout present significant barriers to its application. Furthermore, limitations in TIC training, hospital design and security measures, translation challenges, and hierarchical structures all hinder its integration. Supportive measures include a strong desire to improve health outcomes for communities and patients at FQHCs. CONCLUSIONS Through this first phase of HCD methodology, we identified 7 key insights and design opportunities that lay the foundation for developing solutions to address gaps and enhance the delivery of TIC within safety-net hospitals.