linical Care
Advancing Health Worldwide in Brain and Spinal Injury
The clinical program at San Francisco General Hospital and Trauma Center (SFGH) was created to optimize care for patients with serious brain and spinal cord injuries. This program provides a continuum of care for the neurotrauma patient. Elements of the program include around-the-clock attending neurosurgeon coverage to respond to all major resuscitations, expert neuroscience nurses who assess and intervene to provide the best patient care with the latest advances, and rehabilitative services which include physical therapy, occupational therapy, speech therapy, and physiatry to provide a complete rehabilitative program to maximize recovery. Social work services, including focused inpatient services and the Neurotrauma Outreach Program, integrate patients into the community with appropriate services. Neuropsychology assessment to evaluate a patient’s cognitive strengths and weaknesses, to help identify psychosocial needs, and to assist with community re-integration. Patient and family support through the TBI support group provides a venue for those traumatized by head injury to unite and share their experiences.
San Francisco General Hospital and Trauma Center (SFGHTC) is a licensed general acute care hospital which provides a full complement of inpatient, outpatient, emergency, skilled nursing, diagnostic, mental health and rehabilitation services for adults and children. SFGHTC operates the only Level I Trauma Center for 1.5 million residents of San Francisco, Northern San Mateo, and Marin Counties. It is designated by the San Francisco Emergency Medical Services Agency and verified by the American College of Surgeons Committee on Trauma (ACSOT). Multidisciplinary personnel, resources, equipment and supplies are dedicated to providing total care for every aspect of injury.
The structure of the care delivery system for the trauma patient is based on state of the art treatment, comprehensive injury, prevention programs as well as clinical and laboratory research. The mission of the trauma program is to provide optimal cost- effective trauma care from the time of injury to discharge. The goal of SFGHTC trauma care is returning the trauma patient to his/her pre-injury state. In the late 1960’s, when the results of medical research from the battlefields of Korea and Vietnam began to influence civilian trauma care in the United States, Dr. William F. Blaisdell at SFGH directed innovations in the city’s trauma care system. Staffed by surgeons from the University of California, SFGHTC received National Institute of Health (NIH) grant funding and became a NIH designated trauma research center in 1972.
Since the 1970’s SFGHTC’s Surgical and Neurosurgical staffs have played pivotal roles in setting standards of care in many areas of traumatic injury. In the last 50 years, research in the treatment of injured soldiers and civilians has produced mounting evidence to suggest that seriously injured patients are best served by well-integrated systems of care that activate specialized resources on a moment’s notice and provides expert definitive treatment within an hour. A recent report of evaluated studies of trauma care, consistently demonstrated improvements to the survival of hospitalized patients when high standards of trauma care are incorporated. This translates into nationwide annual estimates of approximately 20,000 to 25,000 lives saved. Through the 1990’s SFGH’s Trauma Center has continued to develop its programs in clinical care, rehabilitation, functional recovery and violence prevention. The current system is trauma center-based; with quality improvement activities focusing on the pre-hospital, emergency and acute care of the most severe injuries.
For more information visit: San Francisco Department of Public Health
Through its long-standing affiliation with the University of California, San Francisco (UCSF), SFGH serves as a training center to one of the top medical programs in the country. SFGHTC promotes academic excellence through its wide range of services for a diverse patient population. In addition to its commitment to providing the best patient care, SFGHTC is also a nucleus for innovative research. The SFGHTC campus is home to more than 20 UCSF research centers, affiliated institutes, and major laboratories. Over 160 UCSF principal investigators conduct research through programs based at the hospital campus. Because it is an academic hospital, SFGH is on the cutting edge of the latest medical advances.
For further information visit: UCSF Department of Neurological Surgery
The Neurotrauma program complies with The Guidelines for the Management of
Severe Head Injury, A Joint Initiative of the Brain Trauma Foundation, the
American Association of Neurological Surgeons and the Joint Section on
Neurotrauma and Critical Care. SFGHTC/UCSF
Neurosurgeons have contributed research authority to this body of evidence and
were key evaluators in 1995, 1999, and 2007. Additionally, the internationally
recognized research staff of the UCSF Brain and Spinal Injury Center brings
cutting edge therapies from the research bench to the clinical bedside. It is
the BASIC Clinical Care Program’s ability to rapidly incorporate these
therapies that set it apart from most medical and trauma centers across the
country.
For further information on the guidelines visit: Brain Trauma Foundation
Uses of technology in the management of severely brain-injured patients has increased over the past decade. Implementing technology to mitigate secondary brain injury must be done with careful consideration and a team approach to achieve the greatest benefit for the patient. Technology routinely used at the bedside includes: intracranial pressure monitoring, cerebral blood flow monitoring, cerebral oxygen monitoring, jugular venous saturation monitoring, sedation and temperature monitoring. Decisions directing the patient’s clinical course are made by expert physicians, nurses and the interdisciplinary team interpreting the data obtained from this technology and crafting interventions individualized to each patient and their pattern of injury. The use of patient-specific treatment guidelines is what sets SFGH apart from most neurotrauma centers across the country.
The Restorative Care Program is a collaborative effort between nursing, rehabilitation, and patient families designed to maximize the restoration of function, prevent deterioration and minimize disability. Providers act as a team to increase mobility, maximize nutritional intake, provide sensory stimulation, and promote receptive and expressive communication skills. This team approach allows families to participate in the recovery of their loved ones and engages staff at all levels of expertise.
Specially trained certified nurse assistants provide constant observation and behavior modification to the head injured patient. The term “sitter” has been replaced by the term “coach” to emphasize the unique role that these providers play. Coach training focuses on safety, redirection and teaching.
Mobility
Sensory Stimulation
Communication
The TBI Clinic was developed to provide a comprehensive assessment of patients with
complex social and medical needs. A multidisciplinary team including
Neurosurgery, Neurology, Physiatry, Neuropsychology, and Social Work screens
patients and refers them to appropriate services in order to maximize
rehabilitation efforts, assist with community reintegration, and minimize
morbidity associated with traumatic brain injury. This unique clinic meets on
a monthly basis and provides care to mildly, moderately and severely brain
injured patients from San Francisco County.
Traumatic Brain Injury Support Group
Consistent with the mission and vision of the Brain and Spinal Injury Center, a Traumatic Brain Injury Support Group was established in 2003. The TBI support group is conducted the first Thursday of every month from 4:30 to 6:00 pm in the Reading Room of the Medical Library. Referrals are made to patients and family through the written and verbal educational process during hospitalization and clinic follow-up, as well as through the city and state TBI referral networks. The TBI Support Group is open to all persons and their families experiencing recovery from Traumatic Brain Injury.
The group is fiscally supported by the Brain and Spinal Injury Center. A wide body of literature has demonstrated that comprehensive patient and family education and psychosocial support improve health outcomes and importantly, patient and family adjustment to life altering illness. The group is co-led by a Clinical Nurse Specialist, a Licensed Clinical Social Worker and a Neuropsychologist. The group strives to provide coordinated and integrated education and psychosocial support for the TBI population and their families. The Group support processes recognize that patients and their families are an integral part of treatment, goal setting, community reintegration, and optimal recovery.
Neurotrauma Outreach Program (NTOP)
NTOP was established in November of 2006 and is a partnership between the SFGH Department of Neurosurgery and the Trauma Recovery Center (TRC). Patients with TBI are initially referred to NTOP while they are on the inpatient units or seen at the Neurosurgery Outpatient clinic for follow-up medical care. Services include: patient and family education about the cognitive, emotional, and behavioral consequences of TBI; case management assistance with practical needs (e.g., obtaining food, housing, financial entitlements); case management assistance to help patients obtain needed aftercare and rehabilitation services; mental health services (psychotherapy and psychiatric medications) to help patients deal with the psychological and emotional consequences of their injuries; and referral to substance use treatment and longer-term mental health treatment.
Last updated October 29, 2009 4:15 PM
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