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INFORMATION FOR

General Medicine Firm(s) at Saint Raphael Campus (SRC)

Introduction

Our residents’ rotations in General Medicine will occur primarily at Yale New Haven Hospital's Saint Raphael Campus. This is the site where the core faculty of the Residency Program have their academic offices and serve as attendings for the teams thus providing the opportunity for all housestaff to work with and be mentored by this highly talented and devoted group of outstanding academic general medicine faculty.

These firms are geographically localized and the majority of admissions come from the emergency department, providing the opportunity for housestaff to manage patients throughout the course of their hospitalization. Attendings are all members of the Yale full-time faculty and there is an added focus on the patient’s experience, educational innovation, inter-professional care, quality, safety and transitions of care. Included among the general medicine Firms is an Advanced Care of the Elderly (ACE) Unit, or the Cooney Firm. This Geriatrics Firm is part of a larger initiative to develop a Center of Excellence in Elder Care at Yale New Haven Hospital.

General Medicine Firm(s) at Saint Raphael Campus (SRC)

The inpatient medical service at the SRC is developed around three main principals: outstanding patient care, excellent attending and peer teaching, and the fostering of strong relationships with other medical services as well as nursing and ancillary staff.

We pride ourselves on our inpatient Firm system where, localized to one general medical unit, we work to deliver true multidisciplinary and team-based care. Our Firms honor the long history of master clinicians from Yale who embody the very best of medicine from clinical excellence to the highest standards of professionalism and devotion to patients. Each Firm is comprised of two teams and each team as dedicated day and night team components working under the supervision of a single attending. There is one PGY 2 or PGY 3 resident with an intern and medical student on each day team and one PGY 2 or PGY 3 resident and an intern on the night team. There are no ”Day Floats” or “Night Floats”, no “holdovers” as all patients are admitted and cared for by physicians who have ongoing responsibility for their care. Within each Firm, faculty, nurses, residents, interns and students work together in a system designed to maximize peer teaching as well as faculty teaching, guidance, and continuity of care. All night and day team members (housestaff and faculty) round together for one hour every morning during “Firm rounds”, where patients admitted to the Firm by the night team are presented at the bedside. These rounds assure a “warm handoff” of the patients and are critical for teaching and learning, as well as for maximizing the patients’ awareness of who their team members are and for patients to gain insight into their illness and to participate in discussion of the proposed plan of care.

Our medical service is designed to maximize collaboration with other hospital staff. This floor is the first unit in the entire Yale New Haven Health that has been designated an Accountable Care Unit (ACU). One hallmark of the ACU model is Structured Interdisciplinary Bedside Rounds (SIBR). In SIBR, all members of the care team including physicians, nursing, pharmacy, physical therapy, social work etc. come together for daily structured bedside rounds. We also have a weekly floor meeting, attended by the medical and nursing staff and led by one of the physician Firm chiefs, where the focus is on collaboration and communication. As a result of these meetings, many initiatives to improve patient care have been designed and implemented.

We view our Firm system as a model for innovation in patient care and education, we welcome new ideas and we are committed to continuous improvement. There are numerous patient-care enhancements, education innovations and academic projects that result each year from collaborative house-staff/faculty/nursing initiatives.

Cooney (Geriatrics) General Medicine Firm

This Firm is our Advanced Care of the Elderly (ACE) service and consists of an attending geriatrician, two general medicine attendings, PGY-II and III residents, interns and students. This Firm is named after Dr. Leo Cooney, a true “master clinician” who has been a leader in geriatric care at Yale New Haven Hospital for several decades. This Firm provides an opportunity to focus on the unique needs of elderly patients with acute illnesses as well as the importance of multidisciplinary care and how to collaborate and coordinate outpatient services with various resources in our community. The Geriatrics Section at Yale is a leader in clinical care delivery, education and research and is closely linked with the Primary Care Program and the Section of General Medicine. We encourage you to learn more about our Geriatrics Section and fellowship program.