Implementation

TQIP participation helped trauma centres identify improvement themes, stimulate quality initiatives, and support a culture of quality. Implementation facilitators include leadership endorsement, clear protocols, and evidence of improved patient outcomes. Surgeon-specific report cards led to action among some surgeons who understood the data. Rural facilities in Tumbes integrated POCT more smoothly than urban facilities because of lower patient demand and more complete training coverage. Open-source baselines and FlashEvolve used the same DSPy client backed by local vLLM for fair comparison. API experiments used the same interface by changing only endpoint and model name. Primary care networks were proposed as more feasible implementation settings than isolated practices. The evaluation examined whether NAT-C training was adequate, whether delivery was faithful, and what implementation issues affected routine use. The trial will use participant interviews and healthcare professional focus groups to explore implementation barriers and facilitators. Future research should evaluate how report cards drive behavioural, cultural, and system-level change among surgeons and hospitals. A dr…