Standard 9.1 from the American College of Surgeons (ACS) requires Level I trauma centers to publish at least 10 trauma-related research articles during each three-year verification cycle. While most centers have little trouble meeting the volume requirement, the administrative burden of running a trauma research and publishing program is significant.
I spoke with Heather Rhodes, PhD, to learn how she uses REDCap, an open-source software platform, to manage an active trauma publishing program.
Three challenges
Dr. Rhodes is a trauma research scientist at Marshfield Clinic Health System, which includes a Level II trauma center in Marshfield, Wisconsin. As the lead facilitator of the center’s trauma research program, she faced three significant challenges:
1. Helping busy trauma surgeons find the time to work on research papers
2. Coordinating the work of several co-authors and keeping publishing projects on track
3. Ensuring that all co-authors make a “substantial contribution” to the published work
The last challenge is particularly important for trauma centers, because the ACS standard now explicitly requires article authors to meet the authorship requirements developed by the International Committee of Medical Journal Editors (ICMJE).
In 2023, Dr. Rhodes was describing these challenges to a member of her organization’s IT team. “I was talking to them about the administrative burden of being a Level I trauma center and all the things I have to capture for research, and they said, ‘Well, that can be done on REDCap.’”
REDCap is an open-source software created to facilitate data capture for research studies. It includes digital survey and database tools that help researchers manage academic research within a secure web application.
Intrigued by these capabilities, Dr. Rhodes began working with Marshfield Clinic programmers to configure REDCap for trauma research.
Essentially, their REDCap configuration creates a structured pathway for taking a trauma research paper from idea to finished manuscript without overburdening the center’s practicing trauma surgeons.
How to use REDCap to facilitate trauma research studies
“The surgeons I work with are extremely busy,” Dr. Rhodes said. “They’re managing residents, they’re in the OR, they’re in the trauma bay, they’re in clinic — so for them, finding time to sit down and write a manuscript is extremely difficult.”
As configured by the Marshfield Clinic team, REDCap facilitates the manuscript development process for busy trauma clinicians.
Manuscript work divided into bite-size pieces. Dr. Rhodes broke down the typical trauma research paper into 10 subsections. She then created 10 questions that function as writing prompts for capturing each subsection’s key information:
- Describe existing information, data, and opinions related to your study based on cited literature.
- Describe the need, relevance, priority for the study and how it will enhance knowledge.
- Explain the weaknesses in the literature. Ask yourself how this study will add to the existing knowledge base.
- Describe the potential impact your study will have in creating a resolution. What do you seek to accomplish?
- Write a brief description of the relative value of the work proposed. Knowledge, improvement in professional practice, and/or contribution to understanding in the field of study must be significantly advanced by the proposed research.
- In one sentence tell the readers your research purpose or objective
- Recap and answer the research question
- What literature in the evidence had similar or congruent findings? What literature in the evidence had differing or incongruent findings?
- Practice Implications: Impact on outcomes? How does this impact current practice? Should current practice change?
- Answer to your primary objective/research question? Major finding?
- Do you approve disseminating this project?
The REDCap system emails links to the above questions to the project’s co-investigators. At their convenience, individual co-investigators can log in to the system and fill in a succinct answer for each survey-style question.
“Essentially, the trauma surgeon gets a little bite of the manuscript work, where they only have to write maybe three sentences and provide a couple of references,” Dr. Rhodes said. “And it’s in a narrative form, not even in a scientific format. We’re just capturing their knowledge and their expertise .”
According to Dr. Rhodes, each question can be answered in about 15 minutes. Even if a surgeon can only log in once every few days, he or she can work through all the questions in just a few weeks.
System captures key information, timestamps and approvals. All contributions are logged within REDCap, with both timestamps and author identifiers. The system also includes tools for automating trauma registry data requests and managing IRB approvals.
“It’s an easy way to insert data and create a database that’s safe and secure,” Dr. Rhodes said. “Many people across the health system can be inputting data and it flows nicely into the same database.”
The overall process also includes three in-person meetings — an initial meeting to discuss the project and plan the background section, a second meeting to review the results, and a final meeting to plan the paper’s discussion section. Meeting attendance records can be maintained within the REDCap system.
Dashboard helps team keep projects on track. The REDCap system sends project participants automated reminders by email to help keep everyone on track. A dashboard provides a complete overview of every research project and allows Dr. Rhodes to keep an eye on the entire workflow.
“It’s really nice because it’s a ‘green light’ system,” she said. “The dashboard shows all the tasks that each clinician has to meet from start to finish, and there is a green light bar that shows their progress.”
The dashboard is accessible by both Dr. Rhodes as trauma research director and the hospital’s trauma medical director.
“Everybody is able to see who’s on track, what’s happening, where they’re at, and what’s coming down the research program pike,” she said. “And there is also accountability because if it looks like someone is stalled, I can jump in and provide support to help the project keep moving forward.”
5 ways the REDCap system supports trauma research goals
The trauma program at Marshfield Clinic adopted REDCap in 2023. According to Dr. Rhodes, the system has helped trauma researchers:
Increase publishing output. In 2023 (pre-REDCap), 7 papers authored by trauma program clinicians were published in medical journals. As of 2024, program clinicians had more than 20 papers in the pipeline and on course for publication.
“It’s made my job a lot easier because it has streamlined all of our projects. We are now able to float many projects at the same time because REDCap is keeping them ordered and structured,” Dr. Rhodes said. “Our productivity has gone way up and our publication success rate is pretty high because of the engagement and clinical involvement.”
Demonstrate compliance with ICMJE requirements. According to ICMJE recommendations, an individual can be considered an author of a research paper only if he or she makes a substantial contribution to the conception or design of the paper or to acquiring, analyzing or interpreting the data it is based on. In addition, authors must take part in drafting the paper or reviewing it critically, give final approval of the published version, and agree to be accountable for the paper’s accuracy and integrity.
“That’s the biggest change from the Orange Book to the Grey Book that really upped the burden of proof for research at a Level I center,” Dr. Rhodes said. “We now have to prove that clinicians are substantially contributing to the research project.”
“Our REDCap system supports that because we now have data showing that a clinician signed in with a password and made a certain contribution,” she said. “And it’s all time-stamped within the system so there is no question that all of the authors are contributing.”
Maintain compliance with data governance policies. The REDCap system also automates requests to access trauma registry data.
“For every project, the system pushes the protocol to the trauma medical director, who can either accept or deny the request,” Dr. Rhodes said.
She noted that all notifications and approvals are recorded within the system. “It’s a seamless tracking system that keeps you compliant with your code of conduct over the governance of the registry.”
Facilitate resident involvement in research. “A lot of residency programs and fellowships are just one year, so it’s hard to work on a paper other than a case review in that short time,” Dr. Rhodes said.
“We have found that our method of breaking down the whole process into writing prompts is good for residents,” she said. “It’s a step-by-step guide to get to publication that we have incorporated into our residency programs, and it’s a good training model for those who don’t know research very well.”
Maintain readiness for ACS reverification review. At the conclusion of a project, the REDCap system automatically generates a research appendix that summarizes the project’s history and the contributions of each author.
“The appendix can be inserted into the ACS Quality Portal (QPort), and then all the pieces are nicely ordered for the College to review during the next survey,” Dr. Rhodes said. “So the system tracks the project from the initial idea all the way to the wrap-up.”
Code available
Standard 9.1 only applies to Level I adult and pediatric trauma centers. However, REDCap can be a useful tool for any trauma center with a research program.
Marshfield Clinic has shared the code map for its REDCap trauma research system with the Coalition for National Trauma Research. Trauma leaders who want to adapt the system for their center can request the code from the CNTR.
“The code map is available for anybody who wants to use it,” Dr. Rhodes said. “It’s open source, which makes it powerful, and we’re really excited about sharing it with other centers.”
