If you really want to know what’s going on in a hospital, don’t
ask a doctor, ask the nurses. That’s one point author Alexandra
Robbins makes in recent book entitled
“The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes
of the Hospital” (ISBN 978-0-7611-8925-1), which is based on a 4-year study of nurses and
health care. Another, more startling, point Robbins makes is: “Don’t
get sick in July.”
Robbins explains that the reason is what is known as “The July Effect”
in some American hospitals. This involves teaching hospitals, affiliated
with a medical school. In July, at teaching hospitals across the country
new medical school graduates start to work as interns, and the experienced
interns move on to residency. This changeover suddenly injects brand new
doctors into a lot of direct care situations with hospital patients. A
National Bureau of Economic Research report describes The July Effect,
according to Robbins, like this: “On day one, new interns may have
the same responsibilities that the now-second-year residents had at the
end of June (i.e., after they had a full year of experience).”
What is the result? Robbins says there is a documented decline in the
quality of patient care. There’s also an increase in medical errors,
as well as medication mistakes that can involve the wrong drug or dosage.
The duration of hospital stays also increases notably in July. But most
alarming is that in July, U.S. death rates at teaching hospitals surge
between 8 and 34 percent—a total of between 1,500 and 2,750 deaths,
according to Robbins. She reports that researchers at the University of
California, San Diego, found
fatal medication errors spiked by 10 percent in July, as opposed to the rate
in other months.
This concern is not limited to American teaching hospitals. Robbins notes
that Great Britain has the problem in August when a similar changeover
of medical personnel occurs. There, it is called “August Killing
Season.” In August, the mortality rate in the U.K. increases by
6 to 8 percent when new doctors are handling procedures that some Britains
say are beyond their capability and degree of experience.
It must be noted that for non-teaching hospital this phenomenon is much
less of a concern. But for teaching hospitals the take away from this
may be this: either avoid having elective surgery in July; or, if you
require surgery in July, avoid a teaching hospital.
