Surgical Clinic at Zuckerberg San Francisco General Hospital

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. Over half of ZSFG patients are at or below the Federal Poverty Level; 11% are uninsured, many are homeless, living in shelters and suffering from multiple drug addictions, all of which create significant challenges to the delivery of care. Yet access to surgical care has been one of the most problematic specialties for uninsured and underserved adults in California. With an average daily census of approximately 200 for surgical services at ZSFG and a no-show rate of 30% at the hospital’s surgical clinic, ~60 patients per day don't receive their intended care. Current evidence indicates that missed appointments can lead to poorer health outcomes for patients, particularly by limiting access and disrupting their continuity of care. The literature also suggests that no-shows are largely correlated with patient-related factors like health literacy and socio-demographics, and focuses on the ramifications for the healthcare system— e.g. disrupted practice workflow, misuse of resources, lost revenue. Much less is understood about the experience of non-attendance from a broader stakeholder perspective and the short- and long-term health outcomes attributed to no-shows. 

Surgical 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. 

Trauma Care for ‘900’ Activations at ZSFG

As a Level 1 Trauma Center, ZSFG handles the most 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 particular cases, designated ‘900’ level trauma activations at ZSFG, require an immediate response that fall under the supervision of both the dedicated Trauma and Emergency Medicine teams. Recent research to improve trauma care, particularly for severe cases, has offered guidance on how both of these teams can collaborate to reduce unintentional harm, patient treatment time, and length of stay. Using The Better Lab methodology, this research aims to build on this literature and identify both short- and long-term interventions to improve ‘900’ activations through close collaboration with staff and patients at ZSFG. Beyond observing how the Trauma Service systems and workflow both succeed and fail, we hope to reveal new technology and device opportunities to enhance care within the Trauma Center and implement changes to improve the patient experience.

We look forward to sharing our experiences with these projects through our blog and social media channels. Stay tuned!


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.