Table 1 Strategies for taking a trauma-informed patient history
From: Trauma-informed care (TIC) best practices for improving patient care in the emergency department
Usual care approach | SAMHSA’s six principles | Trauma-informed care approach |
|---|---|---|
• Seeks to ensure physical comfort • Assume that aggression or resistance is willful on the part of the patient. Does not consider hyper or hypo-arousal response (fight/flight/freeze) • May ask “why are you here?” “What brings you here today?” | Safety | • Assumes that any patient arriving to ED is responding from a hyper/hypo-arousal response (fight/flight/freeze), and as such is alert to cues for danger and may respond with aggression (fight), resistance (flight), or non-responsiveness (freeze) • Uses open-ended questions to explore ways to establish safety or threats to safety • “Is there anything I can do right now that would make you feel more comfortable?” |
• Alerts patient of steps that will be taken, in the order they will happen. “I am here today to take a short history of what happened before you arrived in the ED. Do you mind telling me the events that led up to you coming here?” • Does not focus on building relationships or explaining roles or next steps. If called out of the room unexpectedly will note this and leave: “I am sorry I am being paged” | Trust & transparency | • Begins with provider name, role, time that will be spent with the patient and why, and next steps. “My name is ___, and my role is ___, I am here to learn more about you. It is likely that another provider will also come in and ask you these same questions, as each provider seeks to learn as much as they can about you. I will do my best to relay as much information as I can to the next person. Before we begin, do you have any questions for me about this visit?” |
• Offers patient options for support after visit. “Would you like any resources about what happened to you? I have a sheet I can give you or I can refer you to a social worker who is knowledgeable in these things” | Peer support | • Offers the patient the option of discussing resources and waits for response before discussing. “Would you like me to connect you with anyone or any groups who have experienced similar events as you have?” • If seeking to engage a social worker, explain their role, and explain that the social worker is a reliable referral. Seek to create warm handoffs when possible |
• Alerts patient that care received is on a team-based model. “We will fax a copy of your paperwork to your PCP, so they are updated” | Collaboration & mutuality | • Seeks to make concrete options available to patients about how they can be involved in their current care. “I would like to ensure that we all work as a team during your visit. If you have questions at any point, please ask them, including questions about what is going into your chart. We will also talk about your treatment plan together, so we both feel comfortable with next steps in your care” |
• Offers patients a chance to ask questions and engages patients in the care encounter. “Now that I have explained what’s going to happen today, do you have any questions?” | Empowerment, voice, & choice | • Views the patient as an equal expert and collaborator in care and treatment planning and actively seeks to involve the patient. “You are the expert in your body – what do you think may have been missed thus far?” |
• Does not usually ask about patient culture, gender orientation, or impact of historical issues. May make assumptions about race, ethnicity, gender, or background | Cultural, gender, historical issues | • Seeks to gain a holistic understanding of the patient, so that context of trauma is understood. Inquire out about their lived experiences, customs, and preferences. “Many patients have shared something about themselves, or their preferences for care- is there something we might specifically do for you to address your need” • Ensure a translator is available to collect an accurate history |