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An organizational innovation: the Yale Primary Care Residency Program's experience with a firm system
Dawn M Bravata1, Stephen J Huot
1Department of Internal Medicine, Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, 333 Cedar Street, Room IE-61, SHM, P.O. Box 208025, New Haven, CT 06520-8025, USA. dawn.bravata@yale.edu
Background:
Integrated inpatient-outpatient firms developed in residencies with single institutions may not be applicable to residency programs with multiple inpatient and outpatient training sites. Our objective was to develop a firm in a multisite residency program that improved education and patient care.
Description:
One ward team was restructured into a firm that included two interns, three residents, and four private practice internists whose patients were admitted to the firm. Educational impact, length of stay, hospital charges, and in-hospital mortality were evaluated.
Evaluation:
The firm experience increased outpatient training, fostered mentoring relationships, and increased attending availability. Mean length of stay (5.7 vs. 6.5 days, p = .2) and mean hospital charges ($10,888 vs. $12,316, p = .8) for firm and nonfirm patients, respectively, were not different. In-hospital mortality was lower for firm patients (9 of 348, 3%, vs. 87 of 1,565, 6%; p = .02).
Conclusions:
Firm structures with educational and patient care advantages can be instituted in multisite residencies.