Improving Patient Care at San Francisco General Hospital

It's no secret—health care professionals are overworked. Yet despite a shrinking workforce, hospitals are pushing for faster discharges meaning there is less time to truly talk with patients. And while more people might be “seen” by doctors, quick turnaround times don’t always mean better patient care.

How Negative Hospital Culture Impacts Patient Care

Hope was a young woman who found herself in the trauma unit at San Francisco General Hospital. She had fallen two floors at a rave party leaving her left arm and leg severely fractured. Laurie Barkin, a psychiatric nurse, was working the 4D trauma unit when Hope came in.

One of the charge nurses requested Laurie’s help. She shared with Laurie that, “The trauma team was just in to see Hope and she’s been sobbing ever since.”

When Laurie entered Hope’s room, Hope was propped up in a semi-sitting position. Her eyes were closed, and she was hyperventilating. Suddenly, Hope began to claw at her face with her fingernails in a frenzied motion. Laurie quickly moved to keep Hope from further hurting herself and managed to help Hope relax a bit.

Laurie worked with Hope on breathing exercises to help introduce calm into the situation. That was when Laurie noticed scars up and down Hope’s arms and what looked like cigarette burns on her hands.

It was clear that while Hope had been admitted for physical wounds, there were deeper wounds from trauma that had been re-opened.

After working through the breathing exercises, Hope began to breathe normally again. Slowly, she shared what had happened.

She told Laurie how she had fallen from a swing at the warehouse where the rave was taking place. Laurie also learned that the injuries Hope had sustained were not the cause of her distress.

When Patient Care Suffers

“It’s hard enough not being able to move,” whispered Hope, “but then they treated me like that.”

“Who did,” Laurie asked.

“The doctors, they just barge in and lift up my nightgown like I’m a mannequin, not a person.” 
Laurie listened as Hope explained her encounter with the trauma team.

A trauma resident and a group of students had come into her room earlier to examine her injuries. No one spoke to Hope, and they never asked for permission to lift up her nightgown. During the whole interaction, Hope remained uncertain about the extent of her injuries because no one addressed her.

Laurie later learned from Hope’s therapist that Hope also had a history of childhood sexual abuse that was triggered by the trauma resident and the way he treated her during his examination.

Improving Patient Care

Laurie wrote up a treatment plan for Hope that specifically set limits on staff at the hospital. The plan stipulated that no more than two physicians were allowed to come into Hope’s room at any time, and that a female staff member was required to be present at any examination. Staff also had to ask Hope’s permission to touch her, and they had to make every reasonable attempt to respect her modesty.

Hope’s story is one that is all too common. Packed schedules and stressed-out staff mean that taking time for basic conversations and interactions with patients is becoming less realistic. But it doesn't have to be this way.

The compassion, understanding, and presence of mind that Laurie demonstrated to Hope made all the difference. And it allowed Laurie to write up a treatment plan that decreased instances of distress for Hope and allowed for meaningful patient care to take place.

CPI training provides staff with the skills, understanding, and common language needed to make these kinds of positive patient interactions possible. Learn more about bringing CPI to your facility today.

Originally published in 2015.