The “July Effect”: Is it True that You Shouldn’t Check into the Hospital this Month?

An old joke among medical students asks: “What do you call the person who graduated at the bottom of his/her medical school class?” The answer: “Doctor.” Generally, trips to the hospital or emergency room do not result in you asking your doctors where they went to medical school, what their GPAs were or to see their resumes. But maybe you should — especially in the month of July.

July is the month that new doctors, fresh ink still drying on their medical school diplomas, begin their residencies at teaching hospitals across the country. Rumor among more seasoned doctors is that more errors occur at the hands of new graduates throughout the month, thus creating the “July Effect.”

A recent study indicates that the July Effect may be more than just a rumor. According to a recent issue of the Journal of General Internal Medicine, the University of California at San Diego studied the July Effect by examining death certificates across the country over 27 years. Researchers determined that fatal medication errors increased by 10 percent in counties with a high number of teaching hospitals during the month of July, suggesting that new residents were to blame.

Besides being inexperienced, residents also are often sleep-deprived — often working 36-hour shifts – and trying to acclimate to a new system at their residency hospital. But some medical professionals do not think that new residents are solely to blame. July is generally a hectic month for healthcare professionals with not only new doctors, but also new nurses, pharmacists and other newly graduated caregivers. “There are a lot of new caregivers in July. It’s probably a time where there are a lot of health professionals assuming new responsibilities,” noted Dr. Joanne Conroy, chief health care officer for the Association of American Medical Colleges.

The July Effect in Effect for Connecticut Man?

Connecticut man Stephen Smith entered the hospital on July 3, 2009, for what he thought would be a relatively quick throat surgery. Following the surgery, he began suffering from a heart arrhythmia so his doctor recommended insertion of a pacemaker. The pacemaker surgery lasted 17 minutes, but Smith was left in the hallway, unmonitored, following the procedure while the hospital staff cleaned the operating room. He began to choke on his own saliva. The alarm on the ventilator was not on.

By the time anyone realized what was happening, Smith’s brain had been deprived of oxygen for over a half an hour. Subsequently, he went into cardiac arrest and was revived, but remained in a coma for 10 days. He awoke with severe brain damage and now requires 24-hour nursing care.

His wife never really received an explanation of what went wrong. “I kept asking what happened to my husband and they never gave me an answer. All they kept saying was sometimes things happen during surgeries,” said Benay Smith. An investigation conducted by the Department of Public Health did not suggest that Smith’s exacerbated condition was a result of new residents or nurses, but it did cite the hospital for 10 separate violations of the health code in Smith’s situation. The hospital has since enacted a new policy requiring nurses to stay with patients on ventilators.

So far studies only seem to indicate a pattern in the increase of medication errors that occur during July — not surgical errors. According to researcher/anesthesiologist Allen Bashour who is part of a medical error study at the Cleveland Clinic, “You can have surgery on a Friday afternoon in July and have the same outcome as on a Tuesday morning in October.”

Strategies to Combat the July Effect

While human error will always exist, hospitals have begun taking measures to help combat the so-called July Effect. Many teaching hospitals are providing better supervision of residents and have implemented new policies to prevent mistakes made because of sleep deprivation. Other hospitals are looking at ways to continue prevention — such as using computer software to check for prescription and dosage errors.

Staying Safe in Hospitals: Measures You Can Take to Prevent Errors

Regardless of when your hospital visit is scheduled, there are certain safety measures you can take to protect yourself from medical mistakes:

• Question what is in every medication you are given, and if you are unsure why you are getting it – speak up.
• Bring a medical buddy or advocate to the hospital with you. Have relative or friend who can look out for your best interests. Keep them with you at all times so they can speak on your behalf and keep a written record of what the doctor has told you – especially when you are under the influence of painkillers or drugs that make you groggy.
• Choose a hospital that has the latest technology. Many hospitals have barcode scanners that are used to check patient ID bracelets and medication labels to make sure the proper medication is being administered.
• Carry copies of your own medical records. You have the right to request these from all of your doctors. Your medical information is what a doctor uses to make an accurate diagnosis and often no one doctor has all of it, so if you can provide that information it will reduce the risk of error. Put together a file or binder with your records and include a list of your medications.
• Follow up with your doctor before you leave the hospital. Most hospitals will not have a discharge summary (a summary of everything that happened while you were in the hospital) prepared for you before you leave, but you can still make sure you have all of the information you need for now. Ask your physician to write down dosage information for any new medications – including the purpose of the medication and how often it must be taken. Follow up with any tests that have been administered, and request extra copies of lab reports and test results.

While steps can be taken to help prevent hospital errors, mistakes still happen. If you have been injured as a result of medical negligence, such as a surgical error or medication misdiagnosis it is important to contact an experienced personal injury attorney.