The Yale Center for Healthcare Innovation, Redesign, and Learning (CHIRAL) is a joint venture of Yale School of Medicine (YSM) and Yale-New Haven Hospital (YNHH) that brings together an expert group of physicians, nurses, industrial engineers, communication experts, informatics specialists, sociologists, simulation researchers, clinical researchers and administrators, creating a dynamic learning environment to improve patient safety. CHIRAL will focus on some of the most perilous moments in healthcare: transitions of care. Patients being transferred from one setting to another or one clinical team to another are at increased risk for a host of failures including identification errors, delayed or missed diagnoses, redundant testing, treatment delays or errors, medication errors, and unexpected clinical deterioration. Yet, ensuring the safety of patients during transitions of care has long been one of the biggest challenges facing the healthcare system. CHIRAL aims to improve patient safety at the time of transition through three interrelated and synergistic project based at YNHH. In the first project, we will redesign transfers of patients into our hospital from outside hospitals and emergency departments (EDs). In the second project, we will redesign transfers within our hospital: between our ED or intensive care unit (ICU) and general hospital units. In the third project, we will redesign transfers out of our hospital to the community. All projects will examine transitions through similar conceptual lenses of shared sense making (a collective ability to make sense of complicated, dynamic and ambiguous information without oversimplifying or ignoring discordant data) and latent systems conditions (considering the influence of workflow, skills, culture, staffing patterns, equipment, incentives and information technology). All projects will take a similar design and engineering approach to clinical redesign, beginning with in-depth problem analysis, then preceding through design (brainstorming), development (prototyping), implementation and evaluation phases. Projects will make use of a central Administrative/Operations core, a Simulations core, and an Informatics core. CHIRAL will be closely aligned with hospital and university quality and safety efforts, which will expand its influence and impact.

Public Health Relevance

The Yale Center for Healthcare Innovation, Redesign and Learning will be a dynamic Patient Safety Learning Laboratory focused on improving the safety of patients during transitions of care between clinical settings. These transitions are high risk fr patients. A comprehensive systems-based redesign of care transitions has potential to improve patient safety, reduce adverse events, and increase efficiency.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Center Core Grants (P30)
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Special Emphasis Panel (ZHS1)
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Henriksen, Kerm
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Yale University
Internal Medicine/Medicine
Schools of Medicine
New Haven
United States
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Gawel, Marcie; Emerson, Beth; Giuliano Jr, John S et al. (2018) A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement. Pediatr Emerg Care 34:125-131
Britton, Meredith Campbell; Ouellet, Gregory M; Minges, Karl E et al. (2017) Care Transitions Between Hospitals and Skilled Nursing Facilities: Perspectives of Sending and Receiving Providers. Jt Comm J Qual Patient Saf 43:565-572
Dharmarajan, Kumar; Chaudhry, Sarwat I (2016) New Approaches to Reduce Readmissions in Patients With Heart Failure. JAMA Intern Med 176:318-20