The "July phenomenon" and the care of the severely injured patient: fact or fiction?
BACKGROUND
The "July phenomenon," a common belief in medical academia, refers to purported errors, inefficiency, and negative outcomes during the summertime transition of the house staff. We hypothesized that care in a trauma service is consistent throughout the year and that the July phenomenon therefore is a myth.


METHODS
The records of adults admitted to a trauma service between July 1994 and September 1999 were evaluated. The care of and outcomes for patients admitted in July and August were compared with those of patients admitted in April and May.


RESULTS
Nine hundred seventeen patients were evaluated over 5 years. Patients were well matched by the Injury Severity Score, the Glasgow Coma Score, by mechanism, and by survival probability. Patients admitted in the spring were significantly older, by a mean of 5.1 years. Length of stay and intensive care unit stay were similar. Emergency department times were similar, as were resuscitation times, infection rates, and hospital costs. The mortality of patients was similar between the 2 times.


CONCLUSIONS
There was no evidence of an increase in negative outcomes early in the academic year compared with the end of the academic year. We believe that a systematic approach to the diagnosis, resuscitation, and treatment of trauma prevented a July phenomenon.
Claridge
J A
JA
Department of Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
Schulman
A M
AM
Sawyer
R G
RG
Ghezel-Ayagh
A
A
Young
J S
JS
D000046:Academic Medical Centers / Q000592:standards; D000328:Adult; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D013502:General Surgery / Q000193:education*; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration / Q000592:standards*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D019984:Quality Indicators, Health Care; D012621:Seasons; D015599:Trauma Severity Indices; D014768:Virginia / Q000453:epidemiology; D014947:Wounds and Injuries / Q000145:classification / Q000401:mortality / Q000628:therapy*