Hospital mortality and junior doctors' handover: the role of medical schools and consultants

Abstract

A popular belief amongst physicians in the UK is that the annual influx of newly qualified doctors each August is associated with an increase in hospital morbidity and mortality. Consequently, there have been some changes in working practice such as the introduction of hospital induction programmes and switching the start date from the first day of August to the first Wednesday, which avoids commencing a new employment at the weekend. This perceived problem is not unique to the UK and in the USA it is referred to as the July phenomenon.1 Until now convincing data substantiating this belief was lacking. Jen and colleagues2 recently reported the results of a study comparing mortality rates for patients admitted to hospitals in England on the last Wednesday in July with the first Wednesday in August. This retrospective study scrutinized data for emergency patients admitted on these days followed up for 1 week. Nearly 300 000 admissions were included over a 9-year period. Patients admitted on the first Wednesday in August had a higher death rate than those admitted 1 week earlier on the last Wednesday of July. Medical admissions had a statistically significant, 8% higher, odds ratio of death, but this was not observed with patients whose admission was related to surgery or neoplasia. Medical patients made up nearly 85% of the cohort, however patients admitted with a cancer or surgical diagnosis still accounted for more than 45 000 individuals. It is unclear why there was no effect on mortality in the latter group, but this may reflect smaller, more manageable, numbers of emergency admissions in surgery and oncology often cared for by more experienced junior doctors. Jen et al. followed up for 7 days, a time frame thought to be best for capturing errors caused by failure of training or lack of supervision.3 Surprisingly, the authors gave no further consideration to these aspects of new junior doctors’ performance.