Is “July Effect” Really True? Timing Factors Associated With Rapid Response Events: Experience at a Community-Based Teaching Hospital

Abstract

SESSION TITLE: Quality Improvement 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: “July Effect” refers to the situation where more medical errors are reported in July because it is the beginning of an academic year where fresh medical students and residents start working at a teaching hospital. But we are not sure this is really the case based upon the data. We have analyzed this through rapid response data to see which factors are associated with the rapid response. METHODS: The study took place at a community-based teaching hospital. Rapid response cases were identified through paper-based rapid response records as well as through inpatient electronic health records (EHR) from January 2016 through February 2017. Inclusion criteria are rapid response events happened in the medical-surgical unit and rehabilitation unit. All the events happened in the intensive care unit (ICU), emergency room, outpatient units were excluded. Code Blues were also excluded. Patients demographics (age, gender), as well as the reasons for admission, the timing of the rapid response (time of the day, the day of the week, month) were analyzed. RESULTS: A total of 62 rapid response( RR) cases were identified. Of these, 28 were men and 34 were women. The average age was 62 years(30-92). Reasons for admissions included sepsis (n=8), Acute exacerbation of COPD (n=9), Decompensated heart failure (n=7), Surgical procedure (n=4), alcohol intoxication and withdrawal (n=6) and others (n=26). As to the timing of rapid response, January had the highest number of RR (n=11) followed by July (n=9) and June (n=8). October had the fewest(0). As to the timing of the day, 11 am to 2 pm had the highest incidence of RR(n=18), followed by time window between 2 am and 5 am. Moreover, 27 of rapid response cases occurred within 24 hours of admission. Reasons for calling a rapid response included as follows: Altered mental status (n=11), unresponsiveness (n=11), syncope and presyncope (n=11), Seizure (n=5), Hypoxia (n=11), Cardiac arrhythmia (n=6), and others (n=7). Hemodynamic instability 24 hours prior to the time of rapid response was recorded in a total of 27 cases. Where as, 36 patients had hemodynamic instability( defined as systolic blood pressure of less than 90mm Hg, heart rate greater than 100 beats per minute or less than 50 beats per minute, oxygen saturation of less than 92% at room air, temperature of more than 38 degrees celcius) at the time of RR. CONCLUSIONS: Contrary to the popular belief of “July effect”, June is as bad as July when it comes to the number of rapid response events. Rapid response is called most around the noon time and a large number of cases occur within 24 hours of hospital admission. CLINICAL IMPLICATIONS: We should be as careful at the end of the academic year as at the beginning as implied by our study. Although factors associated with rapid response events could be variable and we cannot simply point out to the timing of the month, we should be mindful of training physicians who are about to finishing their training. We should monitor patients closely during the lunch time when we have noon conferences where the patients are less monitored by the house staff especially for those within 24 hours of their hospital admission. DISCLOSURE: The following authors have nothing to disclose: Humnah Khudayar, Ali Zia, Muhammad Ehtisham, Taro Minami No Product/Research Disclosure Information