Why? On or around July 1, newly graduated interns, residents, nurses and other new health care workers first report to work at many of the nation's hospitals, eager to start practicing medicine — on you. No surprise then, that quality of care in hospitals plummets, and medical errors increase, during the following month.
In the most recent study on the so-called "July Effect" — published earlier this year in the Journal of Neurosurgery: Spine — Mayo Clinic researchers analyzed outcomes of 1 million spinal surgery patients admitted to 1,700 hospitals across the country during July over an eight-year period. Roughly half got surgery at a teaching hospital with newly minted medical students, while the others were treated at nonteaching facilities.
Their conclusion: Patients at teaching hospitals fared only slightly worse — a "negligible effect," wrote the researchers — on criteria such as in-hospital death rates and negative reactions to implanted devices.
"But they also found that compared to others, July patients had higher rates of discharge to other long-term care facilities, as well as post-operative infection and surgical stitches failing," notes David Sherer, M.D., a practicing anesthesiologist and past director of risk management for a large insurance provider, who wrote the book Dr. David Sherer's Hospital Survival Guide.
"Those are three significant outcomes that certainly don't convince me the July Effect doesn't exist," adds Sherer, who was not involved in the Mayo analysis. "And the fact that researchers keep looking into this, asking, 'Is it real?' makes you believe that there's good reason to believe it is. Based on my own experience and speaking with other doctors and patients, I'm convinced the July Effect exists."
Which hospitals are riskiest?
When analyzing the research, it turns out "where" may be even more important than "when." Most studies indicating patients problems during July find higher rates at teaching hospitals — those typically affiliated with a medical school where newly minted medical students get their first on-the-job training.
You may get more personal attention, but the skill level isn't there, explains Sherer. "You have newcomers arriving at hospitals — often placed in a sink-or-swim situation — and they don't know where anything is or how anything is done."
Although as a group these newbies are universally supervised, "from day one, residents are writing medication orders and doing certain procedures and diagnostic tests with relatively little direct supervision, so there's always an opportunity for something to slip through the safety net," adds Christopher Landrigan, M.D., who teaches at Harvard Medical School and oversees residents at Boston Children's Hospital.
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