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Hospital Errors and the "July Effect"


New studies show that hospital deaths increase sharply in July causing a “July Effect”. The study illustrates the need for patients to practice caution while accepting medical care in that month or over the weekend days.

A recent study by the University of California at San Diego demonstrates that fatal medication errors rose 10 percent in July at teaching hospitals in the United States. This “July Effect,” doesn’t seem to mean that hospital staffs are running amok, but that more medication errors seem to be the culprit in teaching hospitals. The study investigated more than 62 million U.S. death certificates between 1976 and 2006. Of those, 244,388 deaths were caused by medication errors in hospitals such as dispensing the wrong medications, overdoses, and accidents involving drugs or biological agents.

The researchers examined certificates of inpatients, outpatients, and those who died in the emergency department, in which medication error was recorded as the primary cause of death. Counties containing teaching hospitals experienced a 10 percent rise in fatal medication errors in July, whereas counties lacking teaching hospitals did not experience that spike.

“There is something going on in teaching hospitals in July, and the most common thing people think of is residents starting,” said David Phillips, lead author of the study and professor of sociology at the University of California at San Diego. Phillips said that they were careful to rule out medication deaths caused by unexpected allergic reactions and didn’t include medication deaths that happened outside of the hospital, which might be the fault of the patient.

What is startling about the recent report on the “July Effect” is that doctors are well aware of the July troubles. “It doesn’t surprise me when you get new residents,” said Dr. David Orentlicher, a medical doctor and professor of law at Indiana University. “Residents are inexperienced, often sleep-deprived, working 36-hour shifts in many cases, and simply may need to learn the system at a new hospital,” added Dr. Orentlicher.

In recent years, doctors say that many teaching hospitals have offered better supervision of residents and new policies are being put into place to help prevent mistakes before they happen. Doctors are making sure residents are not sleep deprived when arriving to work. “There have been some improvements, but I think some of what this shows is the importance of having safeguards built into the system,” said Orentlicher.

Another study shows hospitals operate on the weekend with limited staffing or as some put it, “like they are a 7/11,” leading to an increase in deaths over the weekend in Intensive Care Units (ICU). The study demonstrates that on average, 8 percent of people admitted to ICU’s on weekends were more likely to die than people admitted during the week.

Dr. Paul E. Marik, a Norfolk, Virginia internist who helped conduct the study published in the journal, CHEST, says he sees reasons contributing to that should be very obvious:

  • Low doctor- to- patient ratios.
  • Difficulty obtaining necessary tests and therapies.
  • Scant off -hour staffing.
  • Other administrative problems.

New studies published in the 2008 Journal of the American Medical Association found that people who had heart attacks in the hospital during evenings and weekends were significantly less likely to survive than those who had heart attacks on weekdays. “Hospitals should operate on the same level during the day as at night and people should get the same level of care every day of the week,” said Dr. Marik.

The simplest way for patients to take care of themselves in a hospital is to ask questions and not be afraid to continue asking until you fully understand what you are being told. Don’t assume that a new doctor is familiar with your case; feel free to bring the new physician up-to-date. Verify that the doctors and nursing staff understand and confirm the medications they are giving to you and that they fully explain the purpose and the risks for each medication. Ask medical staff to satisfactorily explain to you what treatments are planned. By asking the hospital staff questions and insisting on full, understandable answers, can be the difference between a good or bad result.

Do not be afraid to go into a hospital in July, but don’t be afraid to ask questions and insist on answers, regardless of month or the day of the week it is. Remember, you are the “customer” and they are the “merchants”.

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