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Entries in Teaching Hospitals (1)

Monday
Jul112011

July Hospitalizations: Inexperienced Doctors Make Them Riskier

Ryan McVay/Thinkstock(SAN FRANCISCO) -- Most doctors will tell you to stay out of teaching hospitals when the new crop of inexperienced medical school graduates begins their training. A new analysis of existing studies adds to the evidence that medical trainee turnover makes July a more perilous time for hospital patients, with more deaths, longer surgeries and longer hospital stays -- not to mention higher hospital charges.

However, Dr. John Q. Young, lead author of the review article, said he doesn't want the findings about the "July effect" to scare sick men and women into staying home.

"Patients should definitely seek the care they need, but beware of the July turnover and know that there's always an experienced attending physician overseeing the care of a trainee. Patients shouldn't hesitate to speak with the supervising physician if they feel anxious about the resident."

In the article, appearing in Tuesday's online edition of the American College of Physicians' Annals of Internal Medicine, Young and his co-authors suggested that potential harm to patients treated in July by newbie physicians could be lessened by more gradually increasing their responsibilities and by pairing the inexperienced interns and residents with veteran physicians.

Young said he and his colleagues systematically reviewed 39 studies published since 1989 because of "a common perception that July is the worst month to be admitted to the hospital." The July effect, he noted, is called "the August killing season" in Great Britain. The enormous variations in the designs and quality of the various studies meant Young and his fellow researchers couldn't quantify the risk to patients hospitalized in July. Nor, he said, could they conclude "which hospitals are doing better and which are doing worse."

According to the article, the departure of experienced trainees and influx of new trainees at U.S. teaching hospitals creates a turnover of 100,000 jobs; the turnover in Europe is 32,000. "As a result, the average experience of the teaching hospital's workforce abruptly declines, established teams are disrupted and many of the remaining trainees are promoted and assume new roles in the care delivery process," Young and his co-authors wrote.

In an accompanying editorial, Dr. Paul Barach, a specialist in perioperative and emergency medicine at the University Medical Center in Utrecht, the Netherlands, and Ingrid Philibert, a top official of the Accreditation Council for Graduate Medical Education in Chicago, which recently implemented changes in medical training, called the new study "superb." They said it highlighted potential dangers to patients who enter hospitals during the July changing of the guard.

The new review "clearly traces the worsening in patient quality and safety by new interns and residents as they advance toward mastering patient care," Barach and Philibert wrote. They suggested that "patients would not consent to care if they knew that the opportunities for residents to learn come at the expense of their welfare."

Earlier this month, U.S. teaching hospitals implemented new regulations from ACGME, which included limiting interns to no more than 16 hours of continuous duty, and requiring direct supervision of interns "until they demonstrate competency that allows them to be supervised indirectly," Young said.

Young said additional studies need to be done to determine which techniques can increase patient safety and mitigate the risks posed by teaching hospitals' July turnover.

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ABC News Radio