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July effect

January 01, 1970

"Killing season" redirects here. For other uses, see Killing Season (disambiguation).

The July effect, sometimes referred to as the July phenomenon, is a perceived but scientifically unfounded increase in the risk of medical errors and surgical complications that occurs in association with the time of year in which United States medical school graduates begin residencies.[1] A similar period in the United Kingdom is known as the killing season or, more specifically, Black Wednesday, referring to the first Wednesday in August when postgraduate trainees commence their rotations. In reality, this phenomenon has not been proven in the scientific literature. In fact, large-scale meta analysis, which has aggregated over 110 studies on this topic, has shown no evidence of a July effect on mortality, morbidity, or readmission.[2]

United States edit

A Journal of General Internal Medicine study, published in 2010, investigated medical errors from 1979 to 2006 in United States hospitals and found that medication errors increased 10% during the month of July at teaching hospitals, but not in neighboring hospitals.[3][4] Surgical errors did not increase, leading to the hypothesis that medication errors are easier for new personnel to make because they are prescribing drugs on their own, rather than being cross-checked by others.[5] The study did not have sufficient data to link the increased errors to new residents, however, and further study would need to be done in order to determine the sources of this increase.[6] A criticism of the study suggests that the supervision of new residents and the patient loads at teaching hospitals have improved since 1979 and that the results may be skewed by including much older data.[7]

Other studies searching for the July effect have found variable evidence of an increased risk, with several studies finding no risk at all.[4]

United Kingdom edit

In Britain, there is an influx of newly qualified doctors into the National Health Service (NHS) each August, and this period is associated with an increase in medical errors. The phenomenon has been recognised by Professor Sir Bruce Keogh, medical director of the NHS. The term "Killing Season" originated in the 1994 British medical drama series Cardiac Arrest written by Jed Mercurio (under the pseudonym John MacUre).[21] In an episode first broadcast on BBC1 on 5 May 1994, the character Dr. Claire Maitland consoles a junior who has just committed a fatal error with the dialogue: "You come out of medical school knowing bugger all. No wonder August is the killing season. We all kill a few patients while we're learning."[22][23]

The day when junior doctors typically start work has also been dubbed "Black Wednesday" among NHS staff. A 2009 Imperial College London study of records for 300,000 patients at 170 hospitals between 2000 and 2008 found that death rates were 6 percent higher on Black Wednesday than the previous Wednesday. The study also found that typically fewer patients attended A&E on the first Wednesday in August than the previous week.[24]

References edit

  1. ^ Zogg, Cheryl K.; Metcalfe, David; Sokas, Claire M.; Dalton, Michael K.; Hirji, Sameer A.; Davis, Kimberly A.; Haider, Adil H.; Cooper, Zara; Lichtman, Judith H. (25 February 2021). "Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes". Annals of Surgery. 277 (1): e204–e211. doi:10.1097/SLA.0000000000004805. ISSN 1528-1140. PMC 8384940. PMID 33914485.
  2. ^ Zogg, Cheryl K.; Metcalfe, David; Sokas, Claire M.; Dalton, Michael K.; Hirji, Sameer A.; Davis, Kimberly A.; Haider, Adil H.; Cooper, Zara; Lichtman, Judith H. (January 2023). "Reassessing the July Effect: 30 Years of Evidence Show No Difference in Outcomes". Annals of Surgery. 277 (1): e204–e211. doi:10.1097/SLA.0000000000004805. ISSN 0003-4932. PMC 8384940. PMID 33914485.
  3. ^ Phillips DP, Barker GE (May 2010). "A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents". J Gen Intern Med. 25 (8): 774–779. doi:10.1007/s11606-010-1356-3. PMC 2896592. PMID 20512532.
  4. ^ a b "New residents linked to July medication errors", amednews, 21 June 2010, American Medical Association
  5. ^ National Public Radio (5 July 2010). "July: A Deadly Time For Hospitals". NPR.org. Retrieved 11 August 2010.
  6. ^ "The 'July Effect': Worst Month For Fatal Hospital Errors, Study Finds", ABC News, 3 June 2010
  7. ^ "Valley Dr.: Surgery's `July effect' outdated", KTAR, 17 June 2010
  8. ^ Yaghoubian A, de Virgilio C, Chiu V, Lee SL (2010). "'July effect' and appendicitis". J Surg Educ. 67 (3): 157–160. doi:10.1016/j.jsurg.2010.04.003. PMID 20630426.
  9. ^ Inaba K, Recinos G, Teixeira PG, et al. (January 2010). "Complications and death at the start of the new academic year: is there a July phenomenon?". J Trauma. 68 (1): 19–22. doi:10.1097/TA.0b013e3181b88dfe. PMID 20065752.
  10. ^ Schroeppel TJ, Fischer PE, Magnotti LJ, Croce MA, Fabian TC (September 2009). "The "July phenomenon": is trauma the exception?". J. Am. Coll. Surg. 209 (3): 378–384. doi:10.1016/j.jamcollsurg.2009.05.026. PMID 19717044.
  11. ^ "'July phenomenon' from new residents debunked", amednews, 26 October 2009, American Medical Association
  12. ^ Alshekhlee A, Walbert T, DeGeorgia M, Preston DC, Furlan AJ (2009). "The impact of Accreditation Council for Graduate Medical Education duty hours, the July phenomenon, and hospital teaching status on stroke outcomes". Journal of Stroke and Cerebrovascular Diseases. 18 (3): 232–238. doi:10.1016/j.jstrokecerebrovasdis.2008.10.006. PMID 19426896.
  13. ^ Garcia S, Canoniero M, Young L (May 2009). "The Effect of July Admission in the Process of Care of Patients with Acute Cardiovascular Conditions". South. Med. J. 102 (6): 602–607. doi:10.1097/SMJ.0b013e3181a2f8ca. PMID 19434039. S2CID 34683280.
  14. ^ Dhaliwal AS, Chu D, Deswal A, et al. (November 2008). "The July effect and cardiac surgery: the effect of the beginning of the academic cycle on outcomes". Am. J. Surg. 196 (5): 720–725. doi:10.1016/j.amjsurg.2008.07.005. PMID 18789415.
  15. ^ Englesbe MJ, Pelletier SJ, Magee JC, et al. (September 2007). "Seasonal variation in surgical outcomes as measured by the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP)". Annals of Surgery. 246 (3): 456–462, discussion 463–465. doi:10.1097/SLA.0b013e31814855f2. PMC 1959349. PMID 17717449.
  16. ^ Kestle JR, Cochrane DD, Drake JM (September 2006). "Shunt insertion in the summer: is it safe?". J. Neurosurg. 105 (3 Suppl): 165–168. doi:10.3171/ped.2006.105.3.165. PMID 16970227.
  17. ^ Myles TD (November 2003). "Is there an obstetric July phenomenon?". Obstetrics and Gynecology. 102 (5 Pt 1): 1080–1084. doi:10.1016/j.obstetgynecol.2003.08.001. PMID 14672490. S2CID 7921069.
  18. ^ Young, John Q.; Ranji, Sumant R.; Wachter, Robert M.; Lee, Connie M.; Niehaus, Brian; Auerbach, Andrew D. (6 September 2011). ""July Effect": Impact of the Academic Year-End Changeover on Patient Outcomes". Annals of Internal Medicine. 155 (5): 309–315. doi:10.7326/0003-4819-155-5-201109060-00354. PMID 21747093.
  19. ^ Thiels, Cornelius A.; Hanson, Kristine T.; Heller, Stephanie F.; Zielinski, Martin D.; Habermann, Elizabeth B. (2016). "Assessment of Patient-Reported Experiences of Hospital Care and the July Phenomenon". JAMA Surgery. 151 (9): 879–880. doi:10.1001/jamasurg.2016.0402. PMID 27248135.
  20. ^ Murtha, Timothy D.; Kunstman, John W.; Healy, James M.; Yoo, Peter S.; Salem, Ronald R. (16 August 2019). "A Critical Appraisal of the July Effect: Evaluating Complications Following Pancreaticoduodenectomy". Journal of Gastrointestinal Surgery. 24 (9): 2030–2036. doi:10.1007/s11605-019-04357-z. PMID 31420859. S2CID 201017743.
  21. ^ Aylin, Majeed (24 December 1994), "The Killing Season – fact or fiction?", The British Medical Journal, vol. 309, no. 6970, p. 1690, doi:10.1136/bmj.309.6970.1690, PMC 2542669, PMID 7819988
  22. ^ Cardiac Arrest The Killing Season, The Internet Movie Database, 5 May 1994
  23. ^ Dillner, Louise (23 April 1994), "Frightening realism", The British Medical Journal, vol. 308, no. 6936, p. 1108, doi:10.1136/bmj.308.6936.1108, S2CID 220175996
  24. ^ "Will patients really die this week because of new NHS hospital doctors?". The Guardian. August 2012. Retrieved 28 September 2013.

External links edit

  • Laerdal Medical: The July Effect – Improving Patient Safety
  • Bakhtiari, Elyas "Preparing for the July Effect: Five Strategies for Integrating New Residents 10 June 2015 at the Wayback Machine, HealthLeaders Media, 7 June 2010
  • Stout CL, Chapman JR, Scoglietti VC, et al. (September 2008). "'July Effect': an evaluation of a level I teaching hospital's trauma service seasonal mortality rates". Am Surg. 74 (9): 878–879. doi:10.1177/000313480807400925. PMID 18807684. S2CID 33794165.
  • Bakaeen FG, Huh J, Lemaire SA, et al. (July 2009). "The July effect: impact of the beginning of the academic cycle on cardiac surgical outcomes in a cohort of 70,616 patients". Ann. Thorac. Surg. 88 (1): 70–75. doi:10.1016/j.athoracsur.2009.04.022. PMID 19559195.
  • Highstead RG, Johnson LC, Street JH, Trankiem CT, Kennedy SO, Sava JA (November 2009). "July – as good a time as any to be injured". J Trauma. 67 (5): 1087–1090. doi:10.1097/TA.0b013e3181b8441d. PMID 19901672.
  • Anderson KL, Koval KJ, Spratt KF (December 2009). "Hip fracture outcome: is there a 'July effect'?". Am. J. Orthop. 38 (12): 606–611. PMID 20145785.

January 01, 1970
july, effect, killing, season, redirects, here, other, uses, killing, season, disambiguation, sometimes, referred, july, phenomenon, perceived, scientifically, unfounded, increase, risk, medical, errors, surgical, complications, that, occurs, association, with. Killing season redirects here For other uses see Killing Season disambiguation The July effect sometimes referred to as the July phenomenon is a perceived but scientifically unfounded increase in the risk of medical errors and surgical complications that occurs in association with the time of year in which United States medical school graduates begin residencies 1 A similar period in the United Kingdom is known as the killing season or more specifically Black Wednesday referring to the first Wednesday in August when postgraduate trainees commence their rotations In reality this phenomenon has not been proven in the scientific literature In fact large scale meta analysis which has aggregated over 110 studies on this topic has shown no evidence of a July effect on mortality morbidity or readmission 2 Contents 1 United States 2 United Kingdom 3 References 4 External linksUnited States editA Journal of General Internal Medicine study published in 2010 investigated medical errors from 1979 to 2006 in United States hospitals and found that medication errors increased 10 during the month of July at teaching hospitals but not in neighboring hospitals 3 4 Surgical errors did not increase leading to the hypothesis that medication errors are easier for new personnel to make because they are prescribing drugs on their own rather than being cross checked by others 5 The study did not have sufficient data to link the increased errors to new residents however and further study would need to be done in order to determine the sources of this increase 6 A criticism of the study suggests that the supervision of new residents and the patient loads at teaching hospitals have improved since 1979 and that the results may be skewed by including much older data 7 Other studies searching for the July effect have found variable evidence of an increased risk with several studies finding no risk at all 4 A 2010 scientific review published in the Journal of Surgical Education found no July effect for patients with acute appendicitis 8 A 2010 study published in the Journal of Trauma found an increased risk of errors that resulted in preventable complications but these errors had no significant impact on mortality 9 A 2009 study published in the Journal of the American College of Surgeons found no month by month differences in outcomes of medical trauma patients 10 11 A 2009 study published in the Journal of Stroke and Cerebrovascular Diseases found no evidence of the July effect for patients with acute ischemic stroke 12 A 2009 study published in the Southern Medical Journal found no difference in the medical management of patients with acute cardiovascular conditions 13 A 2008 study published in The American Journal of Surgery found no seasonal difference in outcomes for cardiac surgery patients 14 A 2007 study published in the Annals of Surgery found a significant seasonal variation with surgical outcomes with an increase in postsurgical morbidity and mortality associated with the beginning of the academic year 15 A 2006 Journal of Neurosurgery Pediatrics study found a small increase in the risks associated with cerebrospinal fluid shunt surgery in children during the months of July and August 16 A 2003 Obstetrics amp Gynecology study found no July effect in obstetric procedures 17 A 2011 systematic review in the Annals of Internal Medicine found that during year end changeovers hospital mortality increases and hospital efficiency decreases 18 A 2016 study in JAMA Surgery found no evidence of the July effect in patient experience outcomes in surgical patients 19 A 2019 study from the Yale School of Medicine found no difference in morbidity or mortality after Whipple procedures pancreaticoduodenectomy performed in July compared to the remainder of the academic year 20 United Kingdom editIn Britain there is an influx of newly qualified doctors into the National Health Service NHS each August and this period is associated with an increase in medical errors The phenomenon has been recognised by Professor Sir Bruce Keogh medical director of the NHS The term Killing Season originated in the 1994 British medical drama series Cardiac Arrest written by Jed Mercurio under the pseudonym John MacUre 21 In an episode first broadcast on BBC1 on 5 May 1994 the character Dr Claire Maitland consoles a junior who has just committed a fatal error with the dialogue You come out of medical school knowing bugger all No wonder August is the killing season We all kill a few patients while we re learning 22 23 The day when junior doctors typically start work has also been dubbed Black Wednesday among NHS staff A 2009 Imperial College London study of records for 300 000 patients at 170 hospitals between 2000 and 2008 found that death rates were 6 percent higher on Black Wednesday than the previous Wednesday The study also found that typically fewer patients attended A amp E on the first Wednesday in August than the previous week 24 References edit Zogg Cheryl K Metcalfe David Sokas Claire M Dalton Michael K Hirji Sameer A Davis Kimberly A Haider Adil H Cooper Zara Lichtman Judith H 25 February 2021 Reassessing the July Effect 30 Years of Evidence Show No Difference in Outcomes Annals of Surgery 277 1 e204 e211 doi 10 1097 SLA 0000000000004805 ISSN 1528 1140 PMC 8384940 PMID 33914485 Zogg Cheryl K Metcalfe David Sokas Claire M Dalton Michael K Hirji Sameer A Davis Kimberly A Haider Adil H Cooper Zara Lichtman Judith H January 2023 Reassessing the July Effect 30 Years of Evidence Show No Difference in Outcomes Annals of Surgery 277 1 e204 e211 doi 10 1097 SLA 0000000000004805 ISSN 0003 4932 PMC 8384940 PMID 33914485 Phillips DP Barker GE May 2010 A July Spike in Fatal Medication Errors A Possible Effect of New Medical Residents J Gen Intern Med 25 8 774 779 doi 10 1007 s11606 010 1356 3 PMC 2896592 PMID 20512532 a b New residents linked to July medication errors amednews 21 June 2010 American Medical Association National Public Radio 5 July 2010 July A Deadly Time For Hospitals NPR org Retrieved 11 August 2010 The July Effect Worst Month For Fatal Hospital Errors Study Finds ABC News 3 June 2010 Valley Dr Surgery s July effect outdated KTAR 17 June 2010 Yaghoubian A de Virgilio C Chiu V Lee SL 2010 July effect and appendicitis J Surg Educ 67 3 157 160 doi 10 1016 j jsurg 2010 04 003 PMID 20630426 Inaba K Recinos G Teixeira PG et al January 2010 Complications and death at the start of the new academic year is there a July phenomenon J Trauma 68 1 19 22 doi 10 1097 TA 0b013e3181b88dfe PMID 20065752 Schroeppel TJ Fischer PE Magnotti LJ Croce MA Fabian TC September 2009 The July phenomenon is trauma the exception J Am Coll Surg 209 3 378 384 doi 10 1016 j jamcollsurg 2009 05 026 PMID 19717044 July phenomenon from new residents debunked amednews 26 October 2009 American Medical Association Alshekhlee A Walbert T DeGeorgia M Preston DC Furlan AJ 2009 The impact of Accreditation Council for Graduate Medical Education duty hours the July phenomenon and hospital teaching status on stroke outcomes Journal of Stroke and Cerebrovascular Diseases 18 3 232 238 doi 10 1016 j jstrokecerebrovasdis 2008 10 006 PMID 19426896 Garcia S Canoniero M Young L May 2009 The Effect of July Admission in the Process of Care of Patients with Acute Cardiovascular Conditions South Med J 102 6 602 607 doi 10 1097 SMJ 0b013e3181a2f8ca PMID 19434039 S2CID 34683280 Dhaliwal AS Chu D Deswal A et al November 2008 The July effect and cardiac surgery the effect of the beginning of the academic cycle on outcomes Am J Surg 196 5 720 725 doi 10 1016 j amjsurg 2008 07 005 PMID 18789415 Englesbe MJ Pelletier SJ Magee JC et al September 2007 Seasonal variation in surgical outcomes as measured by the American College of Surgeons National Surgical Quality Improvement Program ACS NSQIP Annals of Surgery 246 3 456 462 discussion 463 465 doi 10 1097 SLA 0b013e31814855f2 PMC 1959349 PMID 17717449 Kestle JR Cochrane DD Drake JM September 2006 Shunt insertion in the summer is it safe J Neurosurg 105 3 Suppl 165 168 doi 10 3171 ped 2006 105 3 165 PMID 16970227 Myles TD November 2003 Is there an obstetric July phenomenon Obstetrics and Gynecology 102 5 Pt 1 1080 1084 doi 10 1016 j obstetgynecol 2003 08 001 PMID 14672490 S2CID 7921069 Young John Q Ranji Sumant R Wachter Robert M Lee Connie M Niehaus Brian Auerbach Andrew D 6 September 2011 July Effect Impact of the Academic Year End Changeover on Patient Outcomes Annals of Internal Medicine 155 5 309 315 doi 10 7326 0003 4819 155 5 201109060 00354 PMID 21747093 Thiels Cornelius A Hanson Kristine T Heller Stephanie F Zielinski Martin D Habermann Elizabeth B 2016 Assessment of Patient Reported Experiences of Hospital Care and the July Phenomenon JAMA Surgery 151 9 879 880 doi 10 1001 jamasurg 2016 0402 PMID 27248135 Murtha Timothy D Kunstman John W Healy James M Yoo Peter S Salem Ronald R 16 August 2019 A Critical Appraisal of the July Effect Evaluating Complications Following Pancreaticoduodenectomy Journal of Gastrointestinal Surgery 24 9 2030 2036 doi 10 1007 s11605 019 04357 z PMID 31420859 S2CID 201017743 Aylin Majeed 24 December 1994 The Killing Season fact or fiction The British Medical Journal vol 309 no 6970 p 1690 doi 10 1136 bmj 309 6970 1690 PMC 2542669 PMID 7819988 Cardiac Arrest The Killing Season The Internet Movie Database 5 May 1994 Dillner Louise 23 April 1994 Frightening realism The British Medical Journal vol 308 no 6936 p 1108 doi 10 1136 bmj 308 6936 1108 S2CID 220175996 Will patients really die this week because of new NHS hospital doctors The Guardian August 2012 Retrieved 28 September 2013 External links editLaerdal Medical The July Effect Improving Patient Safety Bakhtiari Elyas Preparing for the July Effect Five Strategies for Integrating New Residents Archived 10 June 2015 at the Wayback Machine HealthLeaders Media 7 June 2010 Stout CL Chapman JR Scoglietti VC et al September 2008 July Effect an evaluation of a level I teaching hospital s trauma service seasonal mortality rates Am Surg 74 9 878 879 doi 10 1177 000313480807400925 PMID 18807684 S2CID 33794165 Bakaeen FG Huh J Lemaire SA et al July 2009 The July effect impact of the beginning of the academic cycle on cardiac surgical outcomes in a cohort of 70 616 patients Ann Thorac Surg 88 1 70 75 doi 10 1016 j athoracsur 2009 04 022 PMID 19559195 Highstead RG Johnson LC Street JH Trankiem CT Kennedy SO Sava JA November 2009 July as good a time as any to be injured J Trauma 67 5 1087 1090 doi 10 1097 TA 0b013e3181b8441d PMID 19901672 Anderson KL Koval KJ Spratt KF December 2009 Hip fracture outcome is there a July effect Am J Orthop 38 12 606 611 PMID 20145785 Retrieved from https en wikipedia org w index php title July effect amp oldid 1203886854, wikipedia, wiki, book, books, library,

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