ZSFG Respiratory Care Services
Respiratory Care Services at Zuckerburg San Francisco General has been a renowned leader in respiratory care for over forty years. RCS functions under the guidance of the Department of Anesthesia / School of Medicine at the University of California, San Francisco, one of the world's leading centers of health sciences, research, patient care, and education.
The primary focus of ZSFG Respiratory Care Service is in critical and acute care and features an expanded scope of practice. The department has a growing presence in outpatient clinics and community services. Our Respiratory Care Practitioners serve as consultants to nursing, physician faculty, and all other members of the healthcare team. We are integral members of the Code Blue, Trauma Resuscitation and Medical Emergency Response Teams (MERT).
UCSF - ZSFG partnership Since 1864, the UCSF School of Medicine and Zuckerburg San Francisco General Hospital have worked in close collaboration to provide health care services for the people of San Francisco. UCSF physicians, residents, respiratory care practitioners, and laboratory technicians provide patient care at the ZSFG which is regarded as one of the finest public hospitals in the nation.
Some of UCSF's most groundbreaking research also takes place at ZSFG. For more information about the collaboration between these two leading institutions, please visit UCSF at Zuckerburg San Francisco General.
About Respiratory Care Services
Respiratory Care Services at Zuckerburg San Francisco General Hospital operates within the Department of Anesthesia at the University of California, San Francisco School of Medicine. Our primary focus is in critical care/ emergency care and acute care, in which we have an expanded scope of practice. Therapists are integrally involved in ventilator management and are highly experienced in lung-protective ventilation including the NIH ARDS Network protocol, use of super-PEEP, and high-frequency oscillatory ventilation.
We routinely perform other ancillary therapies such as aerosolized prostacyclin, prone positioning and recruitment maneuvers. In addition, therapists routinely participate in the transport and monitoring of mechanically ventilated patients to special procedure areas and surgery. Our general respiratory care practice includes standard oxygen and aerosol therapy as well as lung expansion and pulmonary hygiene therapies (Incentive Spirometry, EZPAP, Acapella, Metaneb, Cough-Assist), and non-invasive ventilation. Our services emphasize evidenced-based, protocolized management with quality assurance oversight.
Therapists routinely pre-round with the ICU fellow to review the respiratory care plan prior to participating in multidisciplinary rounds with the entire ICU team. Night-shift therapists routinely round with the on-call ICU resident to review current issues and care plans. The Night Shift has an active role in inpatient sleep medicine screening.
In the Neonatal ICU setting therapists assist in high risk deliveries and are highly involved in ventilator management including high-frequency oscillatory ventilation. Therapies provided include inhaled nitric oxide, surfactant administration, High Flow and SiPAP.
Advanced diagnostic testing and monitoring performed by therapists include hemodynamic monitoring (cardiac output determination, vascular resistance studies, mixed venous blood gas determination), jugular venous saturation monitoring, arterial blood gas procurement and point-of-care analysis (punctures and arterial line), physiologic dead-space measurements, pulmonary pressure-volume curves and metabolic studies.
The Respiratory Care Services provide care throughout the hospital. On the general care wards, therapists function primarily as consultants, emergency response and provide care to tracheotomy patients. In addition, RCS provides full service care in the Progressive Care Unit and Emergency Department’s Clinical Decision Unit.
Local, Regional and National Representation / Leadership
Respiratory therapists at ZSFG have served on the AARC program committee, the NIH Delphi Committee on VAP Guidelines, and the National Board for Respiratory Care. Therapists have served as peer reviewers for numerous medical journals including The Lancet, CHEST, Critical Care Medicine, Anesthesia & Analgesia, American Journal of Respiratory, Critical Care Medicine, Critical Care and Intensive Care Medicine as well as serving on the editorial board of Respiratory Care. Over the years department members have held leadership positions within Bay-Area Society for Respiratory Care, the California Society for Respiratory Care and the Respiratory Care Section of the Society of Critical Care Medicine.
The University of California, San Francisco is one of the world's leading centers of health sciences research, patient care, and education. UCSF's medical, pharmacy, dental, nursing, and graduate schools are among the top health science professional schools in the world and are near the top in research funding from the National Institutes of Health.
The UCSF Medical Center is located on the main campus on Parnassus Ave, near Twin Peaks. The UCSF School of Medicine also staffs departments at 4 additional locations: Zuckerburg San Francisco General, Veterans Hospital, Mount Zion Hospital, and the newly opened Mission Bay campus.
Zuckerburg San Francisco General is a licensed general acute care hospital within the Community Health Network, which is owned and operated by the City and County of San Francisco, Department of Public Health. ZSFG provides a full complement of inpatient, outpatient, emergency, skilled nursing, diagnostic, mental health, and rehabilitation services for adults and children. It is the largest acute inpatient and rehabilitation hospital for psychiatric patients in the City. Additionally, it is the only acute hospital in San Francisco that provides twenty-four hour psychiatric emergency services.
ZSFG is world renowned for its expertise in trauma and neurotrauma / neurologic critical care. It is the only Level I Trauma Center for 1.5 million residents of San Francisco and northern San Mateo County. As a UCSF affiliate, ZSFG has a long and distinguished history of research in diverse areas including trauma, neurotrauma / neurologic critical care, AIDS, anesthesia and critical care.
ZSFG Trauma Center
Respiratory Care Services works very closely with the renowned trauma service at ZSFG. ZSFG operates the only level 1 trauma center for more than 1.5 million residents of San Francisco and northern San Mateo County. RCS plays a vital role in the emergency department which treats more than 3,000 severely injured patients every year.
For more information about the ZSFG Trauma center please visit Trauma Team
Recent US News and World Report surveys ranked:
- UCSF Professional / Graduate schools (2006)
- 4th overall among research-based medical schools
- Top 10 in seven of the eight medical school specialty programs assessed
- 1st in AIDS medical care
- 2nd in women's health
- 2nd in internal medicine.
- 5th for drug and alcohol abuse program
- 5th overall in doctoral programs in the biological sciences
- 1st neuroscience
- 3rd third in biochemistry and cell biology programs
- 6th in molecular biology
- 9th in microbiology.
- 9th pediatrics
- 9th geriatrics
- 10th for primary training
- 10th family medicine
- School of Nursing (2003)
- 2nd overall
- In the top 10 in seven of the rated eight nursing specialties:
- 1st family nurse practitioner program
- 2nd training adult/medical-surgical nurses
- 3rd adult nurse practitioner and psychiatric/mental health programs
- 4th pediatric nurse practitioner
- 5th gerontological/geriatric
- 9th community/public health
- School of Pharmacy (2005)
- 1st in the nation
- In addition, the UCSF Medical Center in 2006 was ranked by US News and World Report the 9th-best hospital in the nation, making it the highest-ranked medical center in Northern California.
Respiratory Care Research
Participation in clinical research has been a cornerstone of our department’s culture since the mid-1970s. Respiratory Care Services at SFGH have served as research assistants in several prominent mechanical ventilation studies including studies of Optimal PEEP (N Engl J Med 1975), Mechanism of Shunt Increase on High FiO2 (Anesthesiology 1980) Optimal PEEP and VT Titration (CHEST 1978), Time Course of Lung Recruitment with PEEP (Anesthesiology 1981) and Optimal CPAP (Anesthesiology 1985), Intra-Hospital Transport of the Mechanically Ventilated Patient (Anesthesiology 1989).
Beginning in the mid-1980s therapists have initiated or co-authored numerous studies. Three of the most important studies co-authored by our therapists was the seminal paper on trigger-related work of breathing during mechanical ventilation (CHEST 1985) that stimulated engineering advances in trigger design, the seminal paper on aerosolized pentamidine for the treatment of pneumocystis carinii pneumonia (Lancet 1987)and the landmark paper on the elevated dead-space ventilation in ARDS (N Engl J Med 2002). Since 1985, respiratory therapists at SFGH have published over 60 peer-reviewed papers, and over 100 scientific abstracts as well as chapters for the Textbook of Critcal Care and Egan’s Fundamentals of Respiratory Care.
NIH Funding (2005)
- School of Medicine was the third largest recipient of National Institutes of Health research funds among all US medical schools, receiving 895 awards totaling $398.8 million.
- The Department of Anesthesia within which Respirator Care at SFGH operates ranked first.
- Other Departments ranking first were Dermatology, Internal Medicine, OB, Social Sciences, Neurosurgery
- Other departments in the top ten were Neurology, Biochemistry, Family Medicine, public health, anatomy and cell Biology, Physiology, Surgery and Biostatistics
- The School of Nursing ranked first nationally in total NIH research funds with $13.4 million and 42 awards.
- School of Pharmacy ranked first receiving 44 awards totaling $19.8 million.
- The School of Dentistry in 2003 ranked first receiving 51 awards totaling $28 million from the NIH.
The Department of Anesthesia and Respiratory Care Services utilize cutting edge simulation technology in training and evaluation. The recent addition to the RCS department of the ASL 5000 Active Servo Lung along with the RespiSim Patient Ventilator Interface enables state of the art ventilator management training and bench testing to evaluate new technologies on site.
Since 1993, ZSFG Respiratory Care Services has been presenting an annual all day, 5 CEU seminar on Selected Topics in Intensive Respiratory Care.
The seminar always offers a very diverse range of topics, from the latest trends in Respiratory Care to hot topics of more general interest, such as Hospital Disaster Preparedness and Response in the Post-Katrina Era Civilian Hospital Response to Mass Casualty Events: The Israeli Experience Four Women From Whom Life-Sustaining Therapy Was Withdrawn, Medical Management of Biochemical Weapons Casualties.
During the height of the SARS outbreak in 2002, we interrupted and extended the seminar so that we could show the live feed of the first CDC SARS webcast about the epidemic and CDC's recommendations.
The one trait that characterizes practitioners at ZSFG is their very high skill level, their dedication to their job and unstinting work ethic. The staff turnover ratio is extremely low. Therapists come here and stay - the median length of service is 15 years. Internal and external promotional opportunities are encouraged.
New Hire Orientation
Only Registered Respiratory Care Practitioners are eligible for employment with ZSFG RCS. All newly hired therapists will complete a 12-week orientation and a six month probationary period. Two weeks before the employees first day, a pre employment packet of confidentially agreements, health screening and computer log-on forms must be returned to the department.
The first week of orientation (five 8 hour days) is spent with the Technical Director, Education Coordinator and Clinical Specialists to review policies and procedures and department treatment protocols. The employee will be issued three sets of RCS specific scrubs, assigned a mailbox and locker. There are one day hospital orientations for both UCSF and ZSFG that the employee must attend during their orientation period. During the clinical portion of orientation, orientees are scheduled three twelve hour shifts per week and rotate through all ICU's and care areas of the hospital with a preceptor. Orientation will consist of time on both day and night shifts and with multiple preceptors.
Scheduling The standard clinical work week is 36 hours - three 12 hour shifts per week; Clinical shifts are from 7 – 7. Other roles and opportunities offer other job hours.
Staff meetings General staff meetings are held every month rotating between 7:30 am and 7:30 pm and conference call participation is available.
Operations Meetings Operations meeting for managers, supervisors, and education coordinators are held every month.
Campus Life Services has a mission to strengthen the bonds that make us a strong UCSF community by providing recreational, artistic, social programs. Giants Ballgames, Yosemite Adventures, Family picnics, fun days at Great America park, and noon concerts are just a sampling of the events planned for the UCSF employees.
The Bakar Fitness center at the Mission Bay campus near ZSFG is a brand new full featured recreational facility - two pools, one indoor and one rooftop, a full featured gym with the latest equipment, courts, ping pong. Workout, get a massage, swim in a rooftop pool, climb a wall, then relax at the cafe. It's a pretty exciting place.
So why work at Zuckerburg San Francisco General?
1. You will use all your skill sets and be respected.
2. You will be on the cutting edge of medicine, so your knowledge base will always be expanding.
3. You will enjoy an especially collegial relationship with world class physicians and nurses that have a high regard for our department and your specific skills.
4. You will work with a very knowledgeable, supportive patient orientated staff.
5. You will be in one of the most beautiful and exciting cities in the country.
6. The experience you gain at ZSFG will considerably enhance your resume.
Pathways to Success Beyond SFGH
Respiratory Care Services encourages each employee to develop their talents to their fullest potential. That sometimes means we lose our best employees as they grow into other positions with greater responsibilities elsewhere. The experience therapists have gained at San Francisco General Hospital has helped them obtain positions in management, education, and research.
The experience therapists have gained at San Francisco General Hospital has helped them land high level management positions in private industry
ZSFG RCS Alumni at various times have held these positions
Presidents - US
Vice Presidents - International
Directors - International
Regional Managers - US
Regional Managers - International
Newport Medical (Asia Pacific)
ZSFG RCS Alumni in Private Sector Research
- Inhale Therapeutic Systems
- Nellcor-NCI – Asia/Pacific
- Nellcor - US
Former therapists have been able to land positions in these categories:
- Hospital Administrator
- Directors, Respiratory Care Services
- Education Coordinators
- Instructors and Program coordinators at RC Programs