Avoid Hospital Stays in July!

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.