Yale Center for Healthcare Innovation, Redesign and Learning (CHIRAL)

描述(由申请人提供)：耶鲁医疗创新、重新设计和学习中心(CHILAL)是耶鲁医学院(YSM)和耶鲁-纽黑文医院(YNHH)的合资企业，汇集了一个由医生、护士、工业工程师、通信专家、信息学专家、社会学家、模拟研究人员、临床研究人员和管理人员组成的专家组，创造了一个动态的学习环境来提高患者的安全性。Chial将专注于医疗保健中一些最危险的时刻：医疗过渡。患者从一种环境转移到另一种环境或一个临床团队 另一些人则面临着更高的失败风险，包括识别错误、延迟或遗漏诊断、多余的测试、治疗延迟或错误、用药错误以及意外的临床恶化。然而，在护理过渡期间确保患者的安全长期以来一直是医疗保健系统面临的最大挑战之一。CHILAL的目标是通过YNHH的三个相互关联和协同的项目来提高过渡期间患者的安全性。在第一个项目中，我们将重新设计将病人从医院外和急诊科转移到我们医院的方案。在第二个项目中，我们将重新设计我们医院内部的传输：我们的急诊室或重症监护病房(ICU)与普通医院单元之间的传输。在第三个项目中，我们将重新设计从医院到社区的转接。所有项目都将通过类似的共享意义形成的概念透镜(在不过度简化或忽略不一致的数据的情况下理解复杂、动态和模糊信息的集体能力)和潜在的系统条件(考虑工作流程、技能、文化、人员配置模式、设备、激励和信息技术的影响)来审查过渡。所有项目都将采用类似的设计和工程方法进行临床重新设计， 从深入的问题分析开始，然后经过设计(集思广益)、开发(原型)、实施和评估阶段。项目将利用一个中央行政/业务核心、一个模拟核心和一个信息学核心。手环将与医院和大学的质量和安全努力密切结合，这将扩大其影响力和影响。

DESCRIPTION (provided by applicant): 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.