Safe Patient Care Across the Continuum
CHIRAL facilitates patient safety learning laboratories. The center’s projects incorporate research methodology into quality improvement work, creating flexible, innovative techniques for improving care transitions. Interrelated threats to patient safety are identified, multidisciplinary teams produce new ways of thinking, and innovative design approaches are applied to create interventions that are evaluated in a clinical environment.
The previous work at CHIRAL included three concurrent projects studying transitions of care. While the projects employed a similar design and engineering approach to clinical redesign, each project had a distinct research team, methodology, and focus.
The primary aim of this project was to assess and improve care transitions into the hospital for patients with atraumatic ICH/SAH. The study units were outside sending hospitals and all involved hospital services, including patient transfer service, emergency department, neurology, neurosurgery, diagnostic radiology, pharmacy, blood bank, and bed management. The mixed method data collection included process mapping, observations, semi-structured interviews, real-time surveys, medical record review, and audits and content analysis.
The team shared findings and solicit feedback from all involved parties to inform and validate our analyses. These analyses then informed the design and implementation of a multi-modal intervention to improve the quality and safety of the transfer process.
In this project, the team studied the processes for transferring patients from the emergency department and medical intensive care unit to the general medicine floors. Process analysis included day-in-the-life observations on the units of study; in-depth interviews with key stakeholders including frontline staff; process mapping exercises; and examination of baseline electronic medical record data.
Together with stakeholders, the team identified opportunities for reducing adverse patient events and increasing staff satisfaction with transfers. These efforts included piloted a verbal nursing handoff for patients with special circumstances and investigated cases of contested disposition for patients admitted to general medicine, from both the physician and nurse perspective.
The team partnered with general medicine and geriatrics hospital units, area SNFs, and regional quality improvement efforts to reduce 30-day unplanned hospital readmissions from SNFs and improve the quality and safety of this care transition. Data collection methods included observations at all study units, qualitative interviews, process mapping, root cause analyses of hospital readmissions, and focus groups with patients and caregivers.
The findings and collaborative partnerships were used to implement several improvement efforts, including a warm handoff between clinicians.