UCSF researchers have conducted the first major review of research on the “July effect,” a theory that the quality of health care at teaching hospitals declines during the month of July when experienced residents graduate and newly minted doctors begin their training.
Lead author John Q. Young, MD, MPP, an assistant professor of psychiatry at UCSF, and colleagues reviewed 39 studies published since 1989 to determine whether the year-end changeover of medical trainees theory has merit. The results are mixed.
They found that during the month of July, teaching hospitals do show evidence of higher patient mortality, as well as less efficient care indicated by longer hospital stays, longer surgeries and higher hospital charges.
However, the researchers were unable to gauge the degree of risk posed by the July effect because of the varying methodologies of the many studies included in their analysis.
“While there is mixed evidence, the studies with higher quality designs and larger sample sizes more often showed increased mortality and decreased efficiency at the time of changeover,” said Young, associate director of UCSF’s psychiatry residency training program. “Our findings underscore the need for hospitals to develop approaches to reduce the potential harm of the July effect, so that we can ensure patients are getting the best care year round.”
According to Joshua Adler, MD, chief medical officer of UCSF Medical Center, UCSF has made it a priority to implement measures that counteract the July effect within UCSF Medical Center and UCSF Benioff Children’s Hospital. Among the many patient-safety practices is more supervision and support of residents, Adler said.
“This important analysis provides new insight that teaching hospitals, including UCSF Medical Center, must take seriously,” he said.
The study’s senior author is Andrew Auerbach, MD, MPH, associate professor in the UCSF Division of Hospital Medicine. Additional co-authors include Sumant Ranji, MD, and Robert Wachter, MD, of the UCSF Division of Hospital Medicine, and Connie Lee, MD, and Brian Niehaus, MD, of the UCSF Department of Psychiatry.
The findings appear in the Annals of Internal Medicine.