The July phenomenon revisited: are hospital complications associated with new house staff?
This study was designed to investigate the relationship between the clinical experience of resident physicians and quality of care. This investigation was done by examining the month of the year when patients were treated by resident physicians and a comprehensive set of quality indicators. Quality of care was assessed by a severity-weighted index of adverse events consisting of 47 quality indicators that were screened from 28,541 medical records during a 12-month period. Hospital-wide results indicate that there was no overall relationship between the house officers experience and severity-adjusted adverse events, with the exception of one surgical department that had a higher index of adverse events in the first part of the academic year. Although this study finds no support for a "July Phenomenon" in terms of quality of clinical care, house officers were found to be more likely to have poor documentation practices earlier in the academic year.
Shulkin
D J
DJ
Hospital of the University of Pennsylvania, Department of Medicine, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
D002983:Clinical Competence / Q000706:statistics & numerical data*; D004282:Documentation; D006784:Hospitals, Teaching / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology*; D007396:Internship and Residency / Q000592:standards*; D008499:Medical Records; D015143:Philadelphia / Q000453:epidemiology; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012621:Seasons; D013997:Time Factors