General Surgery Clinic Re-design at ZSFG
Zuckerberg San Francisco General (ZSFG) hospital is the only safety-net hospital in San Francisco and the only Level 1 Trauma Center for San Francisco and San Mateo county residents. With an average daily census of approximately 200 for surgical services at ZSFG and a no-show rate of 30% at the hospital’s general surgery clinic, approximately 60 patients per day don't receive their intended care. Furthermore, the average cycle time for a visit is 2 hours, and patients spend over half of that time waiting to see their provider. Through observations in clinic and interviews with providers, staff and patients, we know that user satisfaction is consistently low due to barriers to access to care, overall clinic efficiency, and the environment of the patient waiting room. We are currently in the prototyping phase of this project, testing solutions to improve access, throughput and experience for all users in the general surgery clinic.
Improving Trauma Rounds at ZSFG
Daily patient rounds are essential for care delivery because they allow for providers to collaboratively develop a care plan while providing the patient and their family the opportunity to communicate with their care team. The trauma service at ZSFG has the highest number and complexity of patients of any other service. Whereas other services complete their rounds in an average of 2 hours, the trauma team can take up to 5 hours each morning visiting their patients. In addition to the high patient census and complexity, there are a variety of non-clinical factors that contribute to the efficiency and experience of the rounding process. This project seeks to uncover those factors and collaborate with users to simultaneously improve the efficiency of the rounding process for the trauma team and enhance the experience of rounds for all users— providers, staff, medical students, interns, patients and their families.
Re-designing the experience of high-level trauma activations at ZSFG
As a Level 1 Trauma Center, ZSFG handles severe trauma cases that require precise coordination of care and shared frameworks across medical teams in order to make appropriate treatment decisions within extremely limited timeframes. These cases, designated ‘900’ level trauma activations at ZSFG, require an immediate response that falls under the supervision of both the Trauma and Emergency Medicine teams. Recent research to improve trauma care, particularly for severe cases, has offered guidance on how teams can collaborate to reduce unintentional harm, patient treatment time, and length of stay. Currently, we are focusing our efforts on re-designing personal protective equipment to encourage and increase use among providers and staff.
VIRTUAL REALITY TRAINING PROGRAM TO IMPROVE TRAUMA CARE
ZSFG is the only Level One trauma center in San Francisco. Of the 255 trauma cases admitted each month, 90 are high-level “900 activations” that require speed and intense coordination across multiple departments. Each trauma team configuration is new as providers and staff rotate by shift and month. To account for the variation in team composition we must have a standard language and process informed by a sense of empathy for each others’ roles, concerns and priorities.
With the support of the HEARTS grant through the San Francisco General Foundation, we are developing a training experience using 360 video and immersive storytelling to help these unique teams work together with greater insight and empathy to improve quality and the care experience for the patients we serve.
A 360 degree camera will be used to document select 900 trauma activations from the perspectives of multiple team members and the patient. We will use these videos to create VR/AR training modules to be experienced on high-definition VR headsets so that trauma providers can experience the 900 from different perspectives. The videos will be enhanced with audio, text and visual cues to explain the goals and concerns from the perspective of the team member represented.
The Wrap App: Enhancing communication and planning for case managers and clients of The Wraparound ProjecT
The Wraparound Project is a hospital-based violence intervention program at UCSF that works to reduce violent injury and criminal recidivism in San Francisco. This important work is largely achieved through the support and guidance of high-risk clients by dedicated and culturally competent case managers. Each client has a complex set of unique risk factors and psychosocial needs that require constant communication and follow-up with their case manager. We are collaborating with The Wraparound Project to create the Wrap App, a dedicated mobile platform intended to enhance communication and planning between case managers and clients to prevent the likelihood of future violent injury.
Re-Imagining Perinatal Care for San Francisco’s Most Vulnerable Populations
In partnership UCSF Health, UCSF & ZSFG OB/GYN and the PTBi-California, we aim to revolutionize perinatal care for vulnerable and publicly insured women in San Francisco by innovating a model of care that improves equity, quality, outcomes and experience. We will focus on understanding this patient population’s unique priorities and challenges. Additionally, we will seek to understand factors that influence the choice of prenatal clinic and delivery hospital. With the insights we gather from the understanding phase, we will develop an outpatient care model that addresses the unique needs of this population and improves the perinatal care experience and health outcomes for mother and baby.