Abstract
BackgroundCommencement of a new academic cycle is presumed to be associated with poor patient outcomes. However, supportive evidence is limited for trauma patients treated in under-resourced hospitals, especially those who require specialized interventions and with little physiological reserve. We examined whether a new academic cycle affects the survival outcomes of injured patients in a typical Japanese teaching hospital.MethodsThis historical cohort study was conducted at a Japanese community emergency department (ED). All injured patients brought to the ED from April 2002 to March 2018 were included in the analysis. The primary exposure was presentation to the ED during the first quartile of the academic cycle (April–June). The primary outcome measure was the hospital mortality rate.ResultsOf the 20,945 eligible patients, 5282 (25.2%) were admitted during the first quartile. In the univariable analysis, the hospital mortality rate was similar between patients admitted during the first quartile of the academic year and those admitted during the remaining quartiles (4.1% vs. 4.4%, respectively; odds ratio [OR], 0.931; 95% confidence interval [CI] 0.796–1.088). After adjusting for the potential confounding factors of the injury severity score, age, sex, Glasgow coma scale score, systolic blood pressure, trauma etiology (blunt or penetrating), and admission phase (2002–2005, 2006–2009, 2010–2013, and 2014–2018), no statistically significant association was present between first-quartile admission and trauma death (adjusted OR 0.980; 95% CI 0.748–1.284). Likewise, when patients were subgrouped according to age of > 55 years, injury severity score of > 15, Glasgow coma scale score of < 9, systolic blood pressure of < 90 mmHg, requirement for doctor car system dispatches, emergency operation, emergency endotracheal intubation, and weekend and night presentation, no significant associations were present between first-quartile admission and hospital mortality in both the univariable and multivariable analysis.ConclusionsAt a community hospital in Japan, admission at the beginning of the academic year was not associated with an increased risk of hospital mortality among trauma patients, even those requiring specialized interventions and with little physiological reserve. Our results support the uniformity of trauma care provision throughout the academic cycle in a typical Japanese trauma system.
Highlights
Commencement of a new academic cycle is presumed to be associated with poor patient outcomes
During the study period, 23,091 trauma patients were brought to the emergency department (ED) (Fig. 1)
We excluded 401 patients who received ongoing cardiopulmonary resuscitation and 1745 patients who were transported from other facilities
Summary
Commencement of a new academic cycle is presumed to be associated with poor patient outcomes. We examined whether a new academic cycle affects the survival outcomes of injured patients in a typical Japanese teaching hospital. Trauma is the representative example of an unplanned critical condition requiring rapid diagnosis and aggressive intervention. A large transition takes place at the beginning of the academic year. In such seasons, many new and inexperienced healthcare providers such as residents, clinical fellows, new graduate nurses, and technicians begin caring for patients. The performance of experienced healthcare professionals may temporarily decline after transfer to a new workplace because considerable time will be required to become accustomed to local systems and hospital rules. Any compromise in the care of injured patients may be likely to have a more pronounced impact at the beginning of the academic year
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