An organizational innovation: the Yale Primary Care Residency Program's experience with a firm system.
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.


METHODS
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.


RESULTS
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.
Bravata
Dawn M
DM
Department 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
Huot
Stephen J
SJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003237:Connecticut; D004504:Education, Medical, Undergraduate; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009936:Organizational Innovation; D010821:Physicians, Family / Q000193:education*