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New residents linked to July medication errors

Nationwide data spanning 27 years shows consistent July spikes in fatal errors at teaching hospitals, a new study finds, contradicting earlier research.

By — Posted June 21, 2010

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The influx of new, inexperienced doctors to residency programs nationwide coincides with a 10% spike in fatal medication errors in July at teaching hospitals, according to a study in the Journal of General Internal Medicine.

The study found a rise of such errors in counties with teaching hospitals in July, but not in any other month. More deaths occurred in counties with greater numbers of teaching hospitals, and counties without teaching hospitals experienced no such spike.

For decades, a common belief among some patients has been to avoid hospitalization during the seventh month of the year because of a suspected higher risk of dangerous errors by doctors fresh out of medical school. With more than 21,000 recent medical school graduates set to begin residency training in July, researchers sought to determine whether there is any truth to the purported "July effect."

They focused on fatal medication errors in hospitals, where errors are "more likely to be influenced by inexperienced residents than by patients." The study examined 62.34 million computerized death certificates from 1979 to 2006, focusing on 244,388 deaths involving medication errors.

"Medication errors are the second-leading cause of accidental death, and the only kind of accidental death that is increasing over time," said study co-author David P. Phillips, PhD. A professor of sociology at the University of California, San Diego, Phillips has studied medication errors -- those attributable to patients as well as to health care professionals -- for more than 30 years.

Previous studies that examined the July effect found little or no impact, said Vineet Arora, MD, assistant professor and associate director for the internal medicine residency program at the University of Chicago Pritzker School of Medicine.

Last year, researchers at the University of Tennessee Health Science Center in Memphis released an analysis of data on 12,525 surgery patients. The study found no difference in deaths or recovery times for patients treated in July versus other months.

Dr. Arora said she was shocked to see the latest findings. "This is indeed a departure and concerning for those of us who are in teaching hospitals. It does give somebody pause. Something appears to be happening in July that leads to this spike."

Phillips said the previous lack of evidence of the trend may be because researchers focused on specific geographic or practice areas. With surgery, for example, new residents routinely work with a team of physicians and medical professionals, and that helps mitigate errors, he said.

As for why the spike occurs only in July, Phillips said the research suggests new residents "learn quickly" from mistakes made that month. "Within a month, they're up to speed."

He said he hopes the study will encourage officials at teaching hospitals to reevaluate what responsibilities are given to new residents, increase supervision and bolster education on medication safety.

"There are many possible errors that could be happening, but we don't know the relative frequency of those errors," Phillips said. "I'm hoping that people will follow this up."

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External links

"A July Effect in Fatal Medication Errors: A Possible Effect of New Medical Residents," Journal of General Internal Medicine, May 29 (link)

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