Lots of data is accumulating that shows avoidable deaths, injuries and medication errors occur at teaching hospitals in U.S. in the month of July every year when fresh and inexperienced PGY-1 Resident doctors start their residencies and are eager to use their medical knowledge and skills on their first patients. This is now commonly known as the "July Effect"!
David P. Phillips, Ph.D., and Gwendolyn E. C. Barker, B.A. published a study (2010) in the Journal Of General Internal Medicine.
They found “the greater the concentration of teaching hospitals in a region, the greater the July Effect for the intra-institutional medication errors in that region”.
Three key themes reportedly emerged during the study:
1) Fatal medication errors spiked in July and no other month.
2) July spike appeared only in counties containing teaching hospitals, and
3) July mortality from medication errors was 10% above the expected level in these counties.
Another interesting finding shows (so called "Weekend Effect") that there is increased mortality in patients who go or are taken to the ER during the weekends when the Attending and the senior faculty is sometimes not available and the burden of care falls on the less experienced Resident doctors and Hospitalists who find it more difficult to reach the patients’ primary care doctors on weekends versus weekdays and have to unravel the medical mysteries from the scratch which is unfair and frustrating for the patients. This leads to the loss of valuable time, in re-diagnosing the patients, which could have been utilized to treat and save their lives. Hospital staffing levels tend to be lower on the weekends than on weekdays. Because of this, weekend ER patients may be less likely to receive invasive procedures and more likely to experience longer in-hospital delays. These invasive procedures have been shown to save more lives when performed early.
Recent studies from Canada, Taiwan, and the United States have reported increased risk of mortality in acute stroke patients arriving to the hospital on the weekend compared to those arriving during the week.
A study published by David J Becker, Ph.D., in the Health Services research in 2007 titled “Do Hospitals Provide Lower Quality Care on Weekends?” concluded:
1) Patients admitted on the weekend are significantly less likely to receive the primary intensive treatments associated with AMI within the first days of their admission.
2) Weekend admission with AMI leads to lower subsequent expenditures, but higher 1-year mortality and a higher rate of one major cardiac complication, readmission with CHF.
3) The effects of weekend admission do vary with patient health status. While weekend admission leads to delays in invasive treatments for all patients, sicker patients (defined by inpatient admission in the prior year) are less likely to experience such delays.
Weekends and the month of July are not a good time to get hospitalized!
Thank you for reading,
Harish Malik, M.D.