Implementation of A “FIRM” Team At a Veterans Affairs Hospital

The “Firm System” is an organizational concept for improving access and continuity of care to patients. At a Veterans Affairs Medical Center, a firm team consists of a medical director, firm coordinator (nurse), program assistant, pharmacist, social worker, and dietitian. Assignment of patients is randomly done by the last two digits of the social security number. Once the patients are entered in a firm, they will always be re-admitted to the same firm on all subsequent hospital admissions, thus facilitating their care. The team rounds daily to provide managed care to the veterans. The interdisciplinary rounds permit instant addressing and solving of problems (e.g. drugs, diet, social problems) Firm team conferences and discharge planning are conducted weekly. The Joint Commission on Accreditation of Health Organizations (JCAHO) currently emphasizes the interdisciplinary delivery of care. According to Dougherty, the performance based model assesses the ability of an organization to carry out key functions that ensures quality patient care. The first step for the firm team was to initiate patient data cards for use during admissions and reference on patient's subsequent admissions. A telephone care program was expanded to expedite patient care by providing early assessment and proper referral of the patients. The firm concept is detailed in a patient care guide given to each patient on admission. In response to the new JCAHO standards, a systematic approach to drug-food interactions was developed; all members are involved in identification and teaching. A discharge planning guide was formatted to recognize each discipline and encourage participation and interaction among firm members for improved planning. Eventually, an outpatient arm of the firm will be initiated to coordinate outpatient care of the veterans.