title: Rate of undesirable events at beginning of academic year: retrospective cohort study.
abstract: OBJECTIVE
  To determine whether an increase in the rate of undesirable events occurs after care provided by trainees at the beginning of the academic year.
  
  
  METHODS
  Retrospective cohort study using administrative and patient record data.
  
  
  METHODS
  University affiliated hospital in Melbourne, Australia.
  
  
  METHODS
  19,560 patients having an anaesthetic procedure carried out by first to fifth year trainees starting work for the first time at the hospital over a period of five years (1995-2000).
  
  
  METHODS
  Absolute event rates, absolute rate reduction, and rate ratios of undesirable events.
  
  
  RESULTS
  The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year (absolute event rate 137 v 107 per 1000 patient hours, relative rate reduction 28%, P<0.001). The overall adjusted rate ratio for undesirable events was 1.40, 95% confidence interval 1.24 to 1.58. This excess risk was seen for all residents, regardless of their level of seniority. The excess risk decreased progressively after the first month, and the trend disappeared fully after the fourth month of the year (rate ratio for fourth month 1.21, 0.93 to 1.57). The most important decreases were for central and peripheral nerve injuries (relative difference 82%), inadequate oxygenation of the patient (66%), vomiting/aspiration in theatre (53%), and technical failures of tracheal tube placement (49%).
  
  
  CONCLUSIONS
  The rate of undesirable events was greater among trainees at the beginning of the academic year regardless of their level of clinical experience. This suggests that several additional factors, such as knowledge of the working environment, teamwork, and communication, may contribute to the increase.
authors.affiliation: Department of Anaesthesia, Pharmacology and Intensive Care, Geneva University Hospital, University of Geneva, 1211 Geneva, Switzerland. Guy.Haller@hcuge.ch
authors.forename: Guy
authors.initials: G
authors.lastname: Haller
authors.forename: Paul S
authors.initials: PS
authors.lastname: Myles
authors.forename: Patrick
authors.initials: P
authors.lastname: Taffé
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Perneger
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000776:Anesthesiology / Q000193:education*; D002983:Clinical Competence / Q000592:standards*; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000193:education* / Q000592:standards; D008875:Middle Aged; D012189:Retrospective Studies; D012621:Seasons; D014739:Victoria