Hospital Visit? Beware the “July Effect”

The medical community and its observers have long suspected a decrease in the quality of care delivered by hospitals in July, the month when newly minted residents arrive at hospitals. A review which appeared recently in the Annals of Internal Medicine confirms the phenomenon.

The purpose was to systematically review studies describing the effects of trainee changeover on patient outcomes. The data was synthesized as follows:

Of the 39 included studies, 27 (69%) reported mortality, 19 (49%) reported efficiency (length of stay, duration of procedure, hospital charges), 23 (59%) reported morbidity, and 6 (15%) reported medical error outcomes; all studies focused on inpatient settings. Most studies were conducted in the United States. Thirteen (33%) were of higher quality. Studies with higher-quality designs and larger sample sizes more often showed increased mortality and decreased efficiency at time of changeover. Studies examining morbidity and medical error outcomes were of lower quality and produced inconsistent results.

And the review concluded:

Mortality increases and efficiency decreases in hospitals because of year-end changeovers, although heterogeneity in the existing literature does not permit firm conclusions about the degree of risk posed, how changeover affects morbidity and safety, or whether particular models are more or less problematic.

The degree of risk may not be firmly established, but the reviewed studies clearly demonstrate that patients and their loved ones who visit hospitals for care during the summer months should be particularly vigilant in monitoring that care to minimize risks.