Peer Review Report For: Collective intelligence informs mechanisms, protocol and toolkit to merge National Ambulance Service data and the Major Trauma Audit to inform the national trauma system [version 1; peer review: 1 approved with reservations]

Background Care following major trauma requires multi-specialty, multi-agency responses and many early-phase critical decisions, requiring synergy to ensure best patient outcomes. The National Ambulance Service (NAS) collects pre-hospital trauma care data, while the Major Trauma Audit (MTA) records data on hospital admission, but no single database encompasses the entire patient journey. The HRB-funded TRAUMA study has merged these databases, but a single research project is insufficient for ongoing, informed decision-making for optimal major trauma care nationally. Therefore, we explored whether stakeholder collective intelligence (CI) engagement techniques could inform best-practice mechanisms for ongoing combining of NAS and MTA datasets in the future. Methods An integrated CI methodology was adopted. 29 stakeholders, representing a variety of organisations and expertise, provided advance input to a trigger question on ongoing challenges to data merging, and solutions for same, then participated in a one-day workshop. During the workshop, user needs were generated using scenario-based design and user-story methods, which were later categorised using the paired-comparison method. Results Stakeholders generated a total of 102 challenges, divided into 12 categories, i.e. governance, legal, resourcing, leadership, professional roles, IT/software issues, interoperability standards and infrastructure, data issues (unique identifier), consent/rights, operational and outcome challenges. Stakeholders generated 82 Information, Operational, and Infrastructure needs (10 categories), and 84 Communication, Collaboration, and Teamwork needs (13 categories). Core elements informed the upgrading of the MTA database after a cyberattack. Conclusions Stakeholder CI has provided a clear roadmap, identifying challenges and user needs which need to be addressed in any comprehensive plan for ongoing database combination for optimal major trauma care nationally. Certain core elements have already been implemented and can inform other audit and registry updating.