July effect
Encyclopedia
The July effect, sometimes referred to as the July phenomenon, is a perceived increase in the risk of medical error
s and surgical complications that occurs in association with the time of year in which medical school
graduates begin residencies
.
A Journal of General Internal Medicine
study, published in 2010, investigated medical errors from 1979 to 2006 and found that medication errors increased 10% during the month of July at teaching hospital
s, but not in neighboring hospitals. 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. 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. 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.
Other studies searching for the July effect have found variable evidence of an increased risk, with several studies finding no risk at all.
Medical error
A medical error may be defined as a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.-Definitions:As a general...
s and surgical complications that occurs in association with the time of year in which medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
graduates begin residencies
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...
.
A Journal of General Internal Medicine
Journal of General Internal Medicine
The Journal of General Internal Medicine is a peer-reviewed medical journal established in 1986 and covering internal medicine in general. It is published by Springer and is the official journal of the Society of General Internal Medicine...
study, published in 2010, investigated medical errors from 1979 to 2006 and found that medication errors increased 10% during the month of July at teaching hospital
Teaching hospital
A teaching hospital is a hospital that provides clinical education and training to future and current doctors, nurses, and other health professionals, in addition to delivering medical care to patients...
s, but not in neighboring hospitals. 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. 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. 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.
Other studies searching for the July effect have found variable evidence of an increased risk, with several studies finding no risk at all.
- A 2010 scientific review published in the Journal of Surgical Education found no July effect for patients with acute appendicitisAppendicitisAppendicitis is a condition characterized by inflammation of the appendix. It is classified as a medical emergency and many cases require removal of the inflamed appendix, either by laparotomy or laparoscopy. Untreated, mortality is high, mainly because of the risk of rupture leading to...
. - 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 mortalityMortality rateMortality rate is a measure of the number of deaths in a population, scaled to the size of that population, per unit time...
. - 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.
- 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.
- A 2009 study published in the Southern Medical JournalSouthern Medical JournalThe Southern Medical Journal is a peer-reviewed medical journal. It is the official publication of the Southern Medical Association. The journal is indexed and abstracted in Index Medicus, Current Contents, Science Citation Index, and EMBASE....
found no difference in the medical management of patients with acute cardiovascular conditions. - A 2008 study published in the The American Journal of Surgery found no seasonal difference in outcomes for cardiac surgery patients.
- A 2007 study published in the Annals of SurgeryAnnals of SurgeryThe Annals of Surgery is a monthly review journal of surgical science and practice. It was started in 1885.-External links:** @ PubMed Central...
found a significant seasonal variation with surgical outcomes, with an increase in postsurgical morbidity and mortality associated with the beginning of the academic year. - A 2006 Journal of Neurosurgery: Pediatrics study found a small increase in the risks associated with cerebrospinal fluidCerebrospinal fluidCerebrospinal fluid , Liquor cerebrospinalis, is a clear, colorless, bodily fluid, that occupies the subarachnoid space and the ventricular system around and inside the brain and spinal cord...
shuntCerebral shuntCerebral shunts are commonly used to treat hydrocephalus, the swelling of the brain due to excess buildup of cerebrospinal fluid . If left unchecked, the cerebral spinal fluid can build up leading to an increase in intracranial pressure which can lead to intracranial hematoma, cerebral edema,...
surgery in children during the months of July and August. - A 2003 Obstetrics and Gynecology study found no July effect in obstetric procedures.