Abstract
BackgroundTo assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work.MethodsData on emergency admissions were derived from Hospital Episode Statistics between 2003 and 2019. A generalised estimating equation model was used to examine whether the introduction of the programme was associated with a change in mortality.ResultsThere were 644,018 emergency admissions, of which 1.8% (7612) ended in death in hospital within a week following the admission. Throughout the study period, there was an annual increase in the number of emergency admissions during July and August, though in-hospital mortality rates declined. The generalised estimating equation analysis found no significant change in the odds of death within 7 days after admission for patients admitted on the first Wednesday in August compared with patients admitted on the last Wednesday in July (OR = 1.03, 95% CI 0.94–1.13, p = 0.53). Furthermore, there was no significant change observed for any clinical diagnosis category following the introduction of the shadowing programme.ConclusionThere was a rising trend in the number of emergency admissions over the study period, though mortality was decreasing. We found no significant association between the introduction of shadowing programme and in-hospital mortality; however, lack of power means that we cannot rule out a small effect on mortality. There are other outcomes that might have changed but were not examined in this study.
Highlights
In the United Kingdom, newly qualified doctors begin their residency training on the first Wednesday in August and has been grimly referred to as “Black Wednesday”, while in North America it happens in July and is known as the “July Phenomenon” [1, 2]
The form of the inductions carried out varied between trusts: from 4 days to a 2-week programme. In this follow-up study, we aimed to investigate whether the introduction of the shadowing programme intervention was associated with a change in the inhospital mortality for patients admitted on the day of the changeover compared with patients admitted on the previous Wednesday in July using the same methodology as our previous study [6]
Throughout the study period, there was a steady increase in emergency admissions during July and August, though in-hospital mortality rates declined (Figs. 1 and 2)
Summary
In the United Kingdom, newly qualified doctors begin their residency training on the first Wednesday in August and has been grimly referred to as “Black Wednesday”, while in North America it happens in July and is known as the “July Phenomenon” [1, 2]. Interest in the potential adverse effects on patient care during this changeover attracted a significant amount of research in the United States [3]. In England, only three studies investigated the association between changeover and adverse patient outcomes, and mixed results were found [4,5,6]. Shuhaiber and colleagues looked at the effect of cardiothoracic resident turnover on cardiac surgical outcomes and found a 30% higher odds of in-hospital mortality after a complex cardiac operation [5]. A later study using administrative hospital data found evidence that patients admitted on the first Wednesday in August. To assess the impact on seven-day in-hospital mortality following the introduction in 2012 of a shadowing programme for new UK medical graduates requiring them to observe the doctor they are replacing for at least 4 days before starting work
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