In the United States, July marks the arrival of new trainees in hospitals and clinics.
Over the years, both anecdotally and formally, researchers have suggested this annual changeover results in lower quality care for patients. Dubbed the "July effect" in America and "the killing season" in the United Kingdom, the idea certainly makes sense. If you were receiving expert treatment at the hospital, wouldn't you prefer the doctor with a year's experience instead of a freshly graduated MD?
But confirming July's reputation as being the worst month to be in the hospital has been difficult, mostly because methods, what doctors measure and statistics vary among studies. One New York Times blog post claims most studies don't report a spike in July deaths.
But most recently, medical doctors think they've confirmed the July effect after conducting an analysis of several studies. Their results are featured in this month's issue of the journal Annals of Internal Medicine.
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Though it's difficult to blame illnesses and deaths on the changeover of medical residents and doctors, the team confirmed an increase in mortalities and a decrease in efficiency (length of stay, cost and so on) among training hospitals in comparison to non-training settings in the month of July.
Doctors assessed the methods of 39 studies and placed them in higher and lower quality groups. Better designed setups involved larger sample sizes and compared data from training facilities to non-training settings during July. The team looked for studies that measured mortality, morbidity, efficiency or medical errors.
Of the studies, roughly 13 were considered "good quality," and it turns out the strongest evidence for mortality increases in July came from higher quality work. Six studies showed a significant difference in mortality between the month of July and other months -- four manuscripts were of higher quality and reported a measurable increase in mortality.
Doctors also found that hospital care was less efficient during this time as well. Studies that recorded morbidity and medical errors produced mix results and some possessed lower quality designs, says the team.
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Could it be that more people -- regardless of hospital -- die in July? It doesn't seem so, according to data from the Centers for Disease Control and Prevention. In fact, U.S. deaths in July are lower in comparison to other months.
Even though the team confirmed the July effect exists, the studies offered little information about the involvement of residents and the level of supervision they work under. Also, it should be noted the analysis was limited to manuscripts written in English and excluded ambulance care.
Still, doctors hope hospitals and residency programs will work to ease the transition into medical practice by starting trainees and residents off with fewer hours and responsibilities.
Though there's reason to be cautious about being hospitalized in July, other research looks at a similar phenomenon comparing weekday care with that provided on weekends. Because hospitals have fewer people on staff on Saturdays and Sundays, patients may have a higher risk of death when compared to their weekday counterparts, according to another study.
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Tags: Modern Medicine
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