According to a recently published study by UC San Diego social scientist David H. Phillips, the month of July is probably the worst time to go to the hospital, at least at teaching hospitals. His study presents the first empirical evidence that lends support to what is known as the “July Effect,” an uptick in the rate of medical errors in July as young, inexperienced doctors begin their residencies in teaching hospitals.
Although there are certainly a few limitations of his research, Dr. Phillips posits that his findings nonetheless suggest “several implications for medical policy—they provide fresh evidence for:
Dr. Phillips and his team began by examining all of the more than 62 million U.S. death certificates from the period 1979-2006. They ultimately whittled that sample down to only those deaths that were attributed to medication errors in hospitals during that time period: 244,388 deaths.
In their analysis, they drew a distinction between counties with teaching hospitals (which utilize residents) and counties without teaching hospitals (which do not utilize residents). In the counties without teaching hospitals, there was no statistically significant month-to-month variation in death rates due to medication errors.
However, Dr. Phillips’ team did find that “in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month. The greater the concentration of teaching hospitals in a region, the greater the July spike.”
Ultimately, they found that there is “a significant July spike in fatal medication errors inside medical institutions. After assessing competing explanations [see page 8 of Dr. Phillips’ article], we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.”
Importantly, Dr. Phillips’ team did NOT observe a trend in the “July Effect” from year to year. Specifically, the number of deaths “did not decline after July 1, 2003, when resident hours were [effectively] reduced” to a maximum of 80 hours per week. Considered alongside their primary finding, that there is empirical evidence for the existence of the “July Effect,” this would suggest that a reevaluation of the responsibilities and supervision of residents might be prudent.
See the full text of Dr. Phillips’ article, as presented in the Journal of General Internal Medicine.
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