By the time a patient with a firearm-related injury arrives at Temple Health, they’ve already experienced an extraordinary amount of trauma. Not only have they been shot and potentially escorted to the hospital by a police officer, but they may have also seen a friend or a loved one injured in front of them. Our job is not only to care for that patient, but to ensure that their time here is as safe and supportive as possible.
That’s why practicing trauma-informed care is so important—and why Megan Healy, MD, Jessica Beard, MD, MPH, and a diverse team of providers, residents, and staff are working hard to make it a cornerstone of Temple Health. That team includes SICU nurse Clyde Williams, RN; Trauma Outreach Manager Scott Charles, MAPP; General Surgery residents Miranda Haslam, MD and Anita Wamakima, MD; and Department of Surgery Psychologist Jeffrey Grand, PsyD.
“Trauma-informed care is all about centering a patient’s feelings of safety and autonomy,” Dr. Healy explains. “We want patients to know that they can trust their care teams, and that they can make choices about what their treatment looks like. They can make decisions, rather than just being told, ‘This is what’s going to happen to you.’ And then, when we do make a care plan, trauma-informed care includes being really clear about what the patient should expect: what procedures are going to happen, how long things are going to take, and who’s going to be working with them.”
Connecting with Care Teams
Over the past two years, Dr. Healy, Dr. Beard, and their team have been educating Emergency Medicine and Surgery residents, faculty, and advanced practice providers on trauma-informed care as part of a pilot program led by the American College of Surgeons’ Committee on Trauma.
Through these conversations, they discovered that patient-facing staff—including nurses, techs, and security team members—also make a significant impact on a patient’s experience. “In particular, security staff—who are often the first personnel a patient interacts with—play an especially critical role,” Dr. Healy says.
With support from a grant from Accelerate Health Equity, which supports projects caring for firearm-injured patients in Philadelphia hospitals, the team was able to hold two focus groups with security staff and nurses to learn about their experiences caring for firearm-injured patients. In the process, they discovered that many security staff members have lived experience with trauma, including various forms of violence.
“That was really eye-opening,” says Dr. Healy. “It means they can be a critical resource in providing trauma-informed care, but also that they can be re-traumatized when they encounter patients with firearm injuries.”
Through this work, the team also learned that stigma and bias can affect patients’ hospital experience, and that a trauma-informed approach must be attuned to power differentials, structural racism, and the larger social context in which they provide medical care.
Designing Innovative Prototypes
Their focus groups inspired the team to organize a Human-Centered Design Workshop in Trauma-Informed Care, held at the Lewis Katz School of Medicine on February 1, 2024. The workshop was facilitated by designers from The Better Lab, led by University of California-San Francisco trauma surgeon Amanda Sammann, MD, MPH.
Nearly 50 participants from across the Health System attended, including nurses, security staff, physicians, and hospital leadership. They worked in multidisciplinary groups to complete an empathy exercise that tracked a firearm-injured patient throughout their hospital stay. Ultimately, the groups produced nine prototype designs to support trauma-informed care at Temple Health.
Some of the most promising prototypes outlined support processes for patient navigation through the hospital and beyond. “One idea was to create an app that would inform patients of their treatment status and different medical interventions that were going to happen, so they could stay up-to-date on their care and understand what the next steps would look like,” Dr. Healy explains. “There was another proposal to have staff members with lived experience of trauma provide support for firearm-injured patients.”
“Another group of participants suggested having an employee in the Trauma Bay with the sole purpose of explaining what’s happening to the patient and making sure the care team is adhering to the principles of trauma-informed care,” Dr. Healy continues. “For example, they might say, ‘It’s getting really loud and hectic in here. Can we stop and describe to the patient what’s going on?’”
In brainstorming next steps with The Better Lab designers, team members also suggested a Trauma Survivors’ Clinic, so that, once firearm-injured patients leave the hospital, they have a place to go that’s designed to aid in their recovery from trauma, and that can connect them with the resources they need.
A Community and Nationwide Leader
The team now plans on taking these ideas to patients to get feedback—and, once they’ve incorporated these comments, to start bringing the proposals to life. “At the same time, we’re also going to be providing education for nurses and security staff around trauma-informed principles,” Dr. Healy explains.
As Dr. Beard sees it, this project is an opportunity for Temple Health to be “a leader in the national movement around trauma-informed care.” It will also allow us to improve the patient experience on a day-to-day level. “Because trauma-informed care is better care, our patients will have better outcomes,” she says. “They’ll be more satisfied with their care, and that will lead to more productive interactions.”
The team’s ultimate goal is to “embed trauma-informed care into the ethos of Temple Health. Those principles shouldn’t just apply to trauma patients—they would improve every patient’s experience, and the way our staff interacts with each other.”
“When people talk about Temple, I want them to think of a place where they’re going to be supported and treated with respect,” Dr. Beard says. “That’s excellent care, and that’s what Temple is.”