The dan­gers of July

Modern Healthcare - - Outliers -

No, it’s not just hos­pi­tal lore—the “July ef­fect” is real. Mor­tal­ity typ­i­cally does in­crease while ef­fi­ciency de­creases dur­ing the month be­cause of hos­pi­tal staff changeovers, ac­cord­ing to a re­view of 39 pre­vi­ous stud­ies posted on the An­nals of In­ter­nal Medicine web­site.

Dur­ing the sum­mer, a new set of in­terns, res­i­dents and fel­lows ar­rive at teach­ing hos­pi­tals, caus­ing an abrupt de­cline in work­force ex­pe­ri­ence, ac­cord­ing to an ar­ti­cle sum­mary.

Univer­sity of Cal­i­for­nia at San Fran­cisco re­searchers, in­clud­ing lead au­thor Dr. John Young and pa­tient-safety ex­pert Dr. Robert Wachter, iden­ti­fied 39 English-lan­guage stud­ies from the U.S., Canada, the United King­dom, Hong Kong and Aus­tralia pub­lished be­tween 1989 and July 2010 that ex­am­ined aca­demic-re­lated turnover of physi­cians in train­ing, used a con­trol group for com­par­i­son, and re­ported the ef­fect of that changeover on pa­tient mor­tal­ity, mor­bid­ity, med­i­cal er­rors and ef­fi­ciency of care, the re­port said.

“It is im­por­tant to note that the ‘July ef­fect’ en­tails both a drop in the clin­i­cal ex­pe­ri­ence of the physi­cians in the sys­tem and a de­crease in the num­ber of physi­cians who are fa­mil­iar with the clin­i­cal sys­tem,” the au­thors con­cluded, and they sug­gested in­ter­ven­tions such as “avoid­ing cog­ni­tive overload and fa­tigue,” strate­gies to pre­vent sys­tem dis­rup­tion (such as stag­gered sched­ul­ing) and more ef­fec­tive sys­tem de­sign.

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