Residents Leave Hospitals And Deaths Increase In "The July Effect"

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Main Category: Medical Students / Training
Also Included In: Medical Practice Management;  Public Health
Article Date: 12 Jul 2011 - 9:00 PDT


July is a bad month to arrive at the hospital. Not because of heat waves, power outages and gas prices, but because the best and most seasoned medical residents leave and the rookies enter the practice system. A new study this week confirms the trend, taking the first comprehensive look at death rates and complications occurring in hospitals throughout the year. Each year in the U.S. the "July Effect" impacts about 100,000 staff in teaching hospitals.

Data was reviewed from 39 previous studies that tracked health outcomes such as death and complications from medical procedures, found that death rates increased between 8% and 34% in July.

Dr. John Young of the University of California, San Francisco clearly explains:

"For me, the metaphor I think of is the football team in a high-stakes game. In the middle of the final drive, the coach sends for four new players to substitute for veteran ones. These new players have never played in the pros before, and the remaining players who do have some experience are sent to assume different positions. And the new team has never practiced together before. This is what happens every July in teaching hospitals with the physician staff."

Of the included studies, 27 (69%) reported mortality, 19 (49%) reported efficiency (length of stay, duration of procedure, hospital charges), 23 (59%) reported morbidity, and 6 (15%) reported medical error outcomes, while all focused on inpatient settings. Most studies were conducted in the United States.

Studies with higher-quality designs and larger sample sizes more showed increased mortality and decreased efficiency at time of the July changeover.

Young notes that such a dramatic shift in personnel rarely occurs in other industries on such a regular basis. Come July, the most experienced residents graduate, leaving behind those who haven't logged as many hours in the clinic or in patient wards. The older residents' departure also coincides with the entry of a new class of freshman residents, or new doctors who are taking on the responsibility of patient care for the first time.

The changeover can disrupt patient care in hospitals, increasing complications from surgery and boosting medical error rates, particularly as new doctors who are unfamiliar with a hospital's pharmacy system mistakenly prescribe wrong doses of medications. The shift also decreases efficiency, with more unneeded or duplicate tests being ordered and patients being kept in the hospital longer than necessary.

In rebuttal, some hospitals ensure that their most experienced physicians are on-call during the summer months, ready to step in and advise or supervise colleagues who might be less confident in their care giving skills. Other centers conduct in-depth orientation sessions to make sure all new doctors are trained in the proper prescribing and care giving procedures.

For those hospitals that don't have such programs in place, the study shows how important instituting them can be. Patients who get sick in July should receive the same level of care as in any other month.

Source: The Annals of Internal Medicine

Written by Sy Kraft
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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