title: Complications and death at the start of the new academic year: is there a July phenomenon?
abstract: BACKGROUND
  The "July Phenomenon" refers to the propensity for increased errors to occur with new housestaff, as they assume new responsibilities at the beginning of the academic year. The purpose of this study was to examine the impact of the new residents presenting in July at a high volume Level I Academic Trauma Center.
  
  
  METHODS
  The trauma registry at the Los Angeles County + University of Southern California Medical center was retrospectively reviewed to identify all injured patients admitted over a 5-year period ending in December 2006. All Morbidity and Mortality reports for the study period were reviewed to extract deaths and any complications classified as preventable or potentially preventable. Patients admitted in the first 2 months (July to August) of the academic year were compared with those treated at the end of the academic year (May to June). Baseline clinical and demographic characteristics were compared, and the rates of preventable and potentially preventable deaths and complications were determined for each of these groups.
  
  
  RESULTS
  During the 5-year study period, 24,302 injured patients were admitted. Of those, 8,151 were admitted during the period from May to August with 4,030 (49.4%) at the beginning of the academic year (July to August) and 4,121 (50.6%) at the end of the academic year (May to June). Overall, the average age was 35.1 +/- 17.7 years, 77% were men with an Injury Severity Score of 8.4 +/- 9.7 and 24.2% penetrating injury rate. When examining mortality, after adjustment for differences between the two groups, there was no difference between patients admitted at the beginning or at the end of the academic year (adjusted odds ratio [95% confidence interval]: 1.1 [0.8, 1.5], p = 0.52). However, when compared with the patients treated for their injuries in May to June, those treated at the beginning of the academic year had a significantly higher rate of preventable and potentially preventable complications (adjusted odds ratio [95% confidence interval]: 1.9 [1.1, 3.2], p = 0.013).
  
  
  CONCLUSIONS
  At an academic Level I trauma center, admission at the beginning of the academic year was associated with an increased risk of errors resulting in preventable and potentially preventable complications; however, these errors did not impact mortality. Specific errors associated with this increased rate of preventable complications warrant further investigation.
authors.affiliation: Division of Trauma Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA. kinaba@surgery.usc.edu
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Gustavo
authors.initials: G
authors.lastname: Recinos
authors.forename: Pedro G R
authors.initials: PG
authors.lastname: Teixeira
authors.forename: Galinos
authors.initials: G
authors.lastname: Barmparas
authors.forename: Peep
authors.initials: P
authors.lastname: Talving
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Carlos
authors.initials: C
authors.lastname: Brown
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data; D011787:Quality of Health Care; D012307:Risk Factors; D014193:Trauma Centers; D014194:Traumatology / Q000193:education*; D014947:Wounds and Injuries / Q000150:complications* / Q000401:mortality / Q000628:therapy