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The "July effect" confirmed at teaching hospitals

July calendar.JPGAs a graduate student in Stanford's Cancer Biology Program, I had my fair share of medical-student friends. It was always interesting to hear their behind-the-scenes perspective on how a teaching hospital really works. I was surprised, though, when more than one told me that I should avoid hospitalization during July. Why? Because that's when new residents begin their medical careers in earnest, along with the inevitable mistakes that come from learning on the job.

Pregnant with my first child, who was due sometime around Aug 1, I was more than a little irritated that they hadn't chosen to share this information with me a bit earlier when I could (maybe) have done something about it. As it was, I took comfort in the fact that no one had proven that the so-called "July effect" was anything but an old wives' tale.

Now researchers at the University of California-San Diego, report that, in fact, in-hospital fatalities related to medication errors spike about 10 percent every year in July. According to, sociologist David Phillips, PhD, and his colleagues reviewed 62 million death certificates spanning a period of time from 1979 to 2006:

This screening revealed a clear and unambiguous July spike, they report in the Journal of General Internal Medicine, published online ahead of print. It showed up only for medication errors, not other causes of death. And, rather disturbingly, Phillips notes, the July blip “didn’t get smaller when medical residents were required to work fewer hours” - i.e. no more than 80 per week, starting in July 2003.

There might be a fix, though:

The solution, Phillips says, should probably be a more gradual transition to autonomy for new doctors. Indeed, he argues, “We provide fresh evidence for reevaluating responsibilities assigned to new residents and increasing the supervision of them.”

Sage advice, it seems. In addition to greater oversight, a recent study by Lucile Packard Children's Hospital pediatricians Paul Sharek, MD, and Christopher Longhurst, MD, showed that implementing a 'computerized physician order entry' system-in parallel with other changes in staffing, process and workflow-can significantly reduce hospital-associated mortality. And the hospital's won numerous awards for patient safety improvements in the past several years.

As for me, my daughter was born July 20 and we went home healthy and happy. She wasn't delivered at Packard Children's, though. My insurance sent me to another, local non-teaching hospital, which, ironically, happened to be undergoing a nurses' strike at the time.

Previously Study shows electronic system to communicate medical orders may save lives

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