YNHH and Yale University collaborate to improve patient transitions

Yale New Haven Hospital and Yale University are collaborating on an initiative to identify and solve safety problems that can occur when patients are transferred to the hospital, within the hospital and after discharge.

In fall 2014, Yale University received a four-year Agency for Healthcare Research and Quality grant to establish the Yale Center for Healthcare Innovation, Redesign and Learning (CHIRAL).

CHIRAL brings together physicians, university representatives and hospital staff from different disciplines to better understand and solve complex patient safety issues that can occur during transfers. These include delays in transport, diagnosis or treatment; misdiagnosis; medication errors; transferring patients to the wrong care team or site; redundant testing; and an unexpected deterioration in patients' conditions.

Through CHIRAL, the hospital has implemented three patient transitions projects that are running simultaneously:

• Examining the transfer of patients from community hospitals' emergency departments to the Yale New Haven Children's Hospital (YNHCH) Emergency Department.
• Examining transitions from one YNHH unit to another, such as transferring patients from a medical intensive care unit or the ED to a different unit.
• Examining transitions for patients discharged from YNHH to skilled nursing facilities.

CHIRAL team members are Meredith Campbell Britton, MSW, social worker, Yale University; Marcie Gawel, RN, YNHCH Pediatric Emergency Department; and Alana Rosenberg, research associate, Yale University. They will spend time on various YNHH units, including the pediatric and adult EDs and MICU at the York Street Campus, and in the community, conducting observations, learning about patient transitions and assessing opportunities to improve patient safety.

CHIRAL is led by Sarwat Chaudhry, MD, project principal investigator and associate professor of medicine, Yale School of Medicine, and Beth Hodshon, RN, project director, Yale School of Medicine. Other principal investigators are Marc Auerbach, MD, assistant professor of pediatrics (emergency medicine), Yale School of Medicine; and Grace Jenq, MD, medical director, Inpatient Medicine, YNHH, and associate professor of medicine, Yale School of Medicine.

Providers and hospital staff are encouraged to report hand-off issues using the online RL solutions event reporting tool on the YNHH intranet. The CHIRAL team will work with staff and hospital leaders to design interventions to address these issues. For more information, email the CHIRAL team.