July Phenomenon Impacts Efficiency of Emergency Care.

Amit Bahl,Catherine Cooley Hixson

doi:10.5811/westjem.2018.10.39885

Amit Bahl, Catherine Cooley Hixson

Open Access

https://doi.org/10.5811/westjem.2018.10.39885

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Abstract

IntroductionThe “July effect” describes the period in which new interns begin learning patient care while senior residents take on additional responsibility in an academic hospital setting. The annual change in staffing creates inefficiencies in patient care, which may negatively impact quality of care. Our objective was to evaluate the impact of the annual resident turnover on emergency department (ED) efficiency in a teaching hospital.MethodsThis was an institutional review board-approved retrospective chart review spanning two academic years analyzing 79,921 records. We grouped July and August into the period of least experience (PLE) and May and June into the period of most experience (PME). Outcomes included faculty and resident productivity, ED door-to-doctor time, and time to disposition.ResultsPatients were evaluated by 117 emergency residents and 73 emergency faculty. We excluded patient records for 35 off-service residents. Residents saw 15.8% more patients in the PME compared to the PLE (p<0.0001). The residents’ average door-to-doctor time during the PLE was 45.63 minutes (standard deviation [SD] 33.01, median 36) compared to 34.69 minutes (SD 25.22, median 28) during the PME, with a decrease in time by 21.3% (p=0.0203). The residents’ average time to disposition during the PLE was 304.6 minutes (SD 308, median 217) compared to 269.0 minutes (SD 282, median 194) during the PME, decreasing by 12.4% (p=0.0001). Residents had an average ED length of stay for discharged patients of 358.5 minutes (SD 374.6, median 238) during the PLE compared to 309.9 minutes (SD 346.4, median 209) during the PME, decreasing 13.7% for discharged patients (p=0.0017).ConclusionAnnual turnover of resident staffing has a significant impact on common ED efficiency metrics. EDs should consider interventions to mitigate the impact of these expected inefficiencies.

Highlights

The “July effect” describes the period in which new interns begin learning patient care while senior residents take on additional responsibility in an academic hospital setting
Residents saw 15.8% more patients in the period of most experience (PME) compared to the period of least experience (PLE) (p
Residents had an average emergency department (ED) length of stay for discharged patients of 358.5 minutes (SD 374.6, median 238) during the PLE compared to 309.9 minutes (SD 346.4, median 209) during the PME, decreasing 13.7% for discharged patients (p=0.0017)

Summary

Introduction

The “July effect” describes the period in which new interns begin learning patient care while senior residents take on additional responsibility in an academic hospital setting. The “July effect” describes the period in which new interns begin learning patient care while senior residents take on additional responsibility and autonomy at teaching hospitals across the country.[1] Within the medical community it has long been assumed that the yearly influx of new resident physicians temporarily decreases hospital efficiency, and may contribute to hospital crowding, medical errors and increased wait times for patients.[1,2,3,4,5,6,7,8] Despite these concerning findings, some studies have argued against the “July effect” as a clinically significant entity. Several studies found no change in morbidity and mortality during resident turnover in the fields of surgery and obstetrics.[9,10] At times the media, e.g, an essay “It’s July, the Greenest Month in Hospitals, No Need to Panic” published in the New York Times, have attempted to overtly refute the July phenomenon and reassure the community.[1]

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