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

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 (FQHCs), as their patients disproportionately experience trauma due to the impacts of socioeconomic determinants of health, including limited health care access, systemic racism, and housing insecurity. There is limited literature on 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 shared challenges faced by providers implementing TIC within 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 to provide TIC within the acute care ecosystem. In this inspiration phase, we conducted 18 semistructured interviews with providers delivering surgical care at an FQHC in Northern California. Interviewers 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 were conducted to identify tensions between stakeholder needs and to elucidate design opportunities to improve their ability to deliver TIC. Results: Inductive analysis identified 21 unique themes and 7 insights that affect 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 the human-centered design 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.