'July effect' in teaching hospitals increases odds patients will die

How many hospital patients are injured or killed as a result of hospital errors? "We do not really know how many people die or suffer needlessly," says Dr. Peter Pronovost, medical director of the Center for Innovations in Quality Patient Care at Johns Hopkins University. "We know it's a lot." According to one estimate, 100,000 people die each year from infections they acquire in the hospital. And scores of thousands die as a result of wrong diagnoses or mistakes in treatment. istockphoto

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(CBS) It's summertime, and the living is easy - unless you need treatment from a teaching hospital. Then you might be lucky just to get out.

A new study reports that more patients receive worse-quality care or die at teaching hospitals during July because experienced residents shuffle off to greener pastures, leaving untrained "newbies" to take their spots and learn the ropes.

PICTURES: 12 ways you risk killing yourself this summer

"The 'July Effect' occurs when these experienced physicians are replaced by new trainees who have little clinical experience, may be inadequately supervised in their new roles, and do not yet have a working knowledge of the hospital system," Dr. John Q. Young, associate program director for the Residency Training Program at the University of California - San Francisco School of Medicine said in a written statement. "It's a perfect storm."

Sounds scary. However, the "July effect" is a more pleasant nickname than what England calls this effect - "August killing season."

Researchers reviewed 39 studies from 1989 to July 2010 that looked at hospital turnover and its impact on patient care, for the study published in the July 12th issue of Annals of Internal Medicine. They found that in July, patients are more likely to die - or receive less efficient care - in the form of longer hospital stays and surgery times, and more unnecessary tests. The authors estimate this turnover affects more than 100,000 U.S. doctors each year.

"For me, the metaphor I think of is the football team in a high-stakes game," Dr. Young told Time. "In the middle of the final drive, the coach sends for four new players to substitute for veteran ones. These new players have never played in the pros before, and the remaining players who do have some experience are sent to assume different positions. And the new team has never practiced together before - this is what happens every July in teaching hospitals with the physician staff."

But new residents shouldn't take all the blame. The authors stress that the "July effect" includes both a drop in clinical experience and a drop in the number of physicians who are familiar with the hospital. One study found fifth-year trainees that enter a new system are just as likely to make mistakes.

Many teaching hospitals are already aware of this effect, and try to counter it by having their "best" doctors on call throughout July, or by finding ways to reduce fatigue in new doctors. The study authors suggest hospitals should stagger new residents' start-times to avoid the abrupt transition that occurs each July.

Either way, patients may want to check the date on a doctor's diploma if they visit hospitals this summer.

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