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.
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
Dawn M
DM
Bravata
Stephen J
SJ
Huot
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*