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

Abstract:

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.

journal_name

Teach Learn Med

authors

Bravata DM,Huot SJ

doi

10.1207/S15328015TLM1403_9

keywords:

subject

Has Abstract

pub_date

2002-07-01 00:00:00

pages

182-8

issue

3

eissn

1040-1334

issn

1532-8015

journal_volume

14

pub_type

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