title: Mortality among high-risk patients admitted with septic shock to U.S. teaching hospitals in July: Does the 'July Effect' exist?
abstract: BACKGROUND
  The 'July effect' is a phenomenon of inferior delivery of care at teaching hospitals during July because of relative inexperience of new physicians.
  
  
  OBJECTIVE
  To study the difference in mortality among septic shock patients during July and another month.
  
  
  METHODS
  Using the U.S. Nationwide Inpatient Sample, we estimated the difference in mortality among septic shock patients admitted during May and July from 2003 to 2011.
  
  
  RESULTS
  117,593 and 121,004 patients with septic shock were admitted to non-teaching and teaching hospitals, respectively, in May and July. High-risk patients had similar mortality rates in non-teaching hospitals and teaching hospitals. Mortality rates were higher in teaching versus non-teaching hospitals in high-risk patients both in May and July. Overall, mortality rates were higher in teaching versus non-teaching hospitals both in May and July.
  
  
  CONCLUSIONS
  Similar trends in mortality are observed in both settings in May and July and no "July effect" was observed.
authors.affiliation: Department of Pulmonary/Critical Care, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA. Electronic address: saqib.amina@gmail.com.
authors.forename: Amina
authors.initials: A
authors.lastname: Saqib
authors.affiliation: Department of Hematology/Oncology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
authors.forename: Uroosa
authors.initials: U
authors.lastname: Ibrahim
authors.affiliation: Department of Medicine, Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia, PA 19129, USA.
authors.forename: Parshva
authors.initials: P
authors.lastname: Patel
authors.affiliation: Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
authors.forename: Abhyudaya
authors.initials: A
authors.lastname: Joshi
authors.affiliation: Department of Pulmonary/Critical Care, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Chalhoub
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment; D012621:Seasons; D012772:Shock, Septic / Q000401:mortality*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: July effect; Non-teaching hospital; Sepsis mortality; Septic shock; Teaching hospital