HSR in the Annals of Internal Medicine this week examining an important question that has perhaps not received the attention it deserves. See also the accompanying editorial.
“July Effect”: Impact of the Academic Year-End Changeover on Patient Outcomes
This was a super informative article, especially the systematic review.
ReplyDeleteTwo things came to mind as I read: (a) why is it such a challenge to maintain safe patient care throughout the year; and (b) how much does the July Effect impact the measurement of quality?
The changeover effect makes complete sense in my mind, especially for a teaching hospital. In many ways, it's comparable to the difficulties a company faces during periods of high turnover-- i.e. loss of familiarity/institutional memory, inexperience, having to "rebuild," etc.
The editorial offers some mitigating solutions, but I'm a little skeptical about the chances of these good ideas being implemented. I think to fully address this effect, we'll need to look at both education (e.g. modifying med school curriculum to enable students to be comfortable with making good decisions, etc.) as well as medicine.
It's a very good and important question for us to address (hopefully through HSR!): how do we achieve and maintain "consistent performance at high levels of safety at all periods," so that medicine can have the same safety standards as air travel or nuclear reactors (as the article says).
For now though, I think I'm going to try to stay as far away as possible from hospitals during the summer, especially in July!