Hospital Errors in July
Here's a new meaning for the phrase "dog days of summer." A study from the University of California at San Diego has found that July is the deadliest month for hospital errors. All other months, the rate of medication mistakes within hospitals stays about even, but in July, that rate consistently spikes by 10%.
The researchers reviewed 62 million U.S. death certificates issued between 1979 and 2006. Of those, 244,388 listed medication errors in a hospital as the cause of death. That's a disturbingly high quarter of a million people who died unnecessarily because someone in the hospital messed up their medication. The errors included accidental overdose of a drug, wrong drug given, drug taken inadvertently, and accidents in drugs used in medical and surgical procedures. Mind you, that doesn't mean that only 244,000 people died from medication errors in this time period. Rather, it means that 244,000 such errors got reported. You can bet that plenty of unreported deaths related to mistakes involving medication go unreported. Also, the study did not include medication deaths caused by allergic reactions or medication deaths that occurred after patients got released from the hospital. It also didn't include nonfatal medication errors. But the point of the study was that the problem gets even worse in July. Although overall hospital admissions are down in July, rates of fatal medication errors go up.
The author of the study, Dr. David Phillips, blames new residents fresh out of medical school for the July spike. July, apparently, is the month when medical school graduates start their residencies at hospitals. In fact, though Phillips surveyed hospitals from coast to coast, he only found the so-called "July effect" in counties that had a high number of teaching hospitals. Those counties that did not have many teaching hospitals showed no spike in fatal medication errors in July, and, the report notes, "the greater the concentration of teaching hospitals in a region, the greater the July Effect." Now that little tidbit of information could cause you to watch Scrubs reruns with a different frame of mind.
Certainly, inexperience among medical interns and residents may be a major factor. Dr. David Orentlicher of Indiana University says, "You've got people who are inexperienced. You've also got people who are trying to learn a new system." But then he added, "When you are transitioning and you are handing off patients to a new provider, not all of the information is communicated." In other words, the more experienced doctors may dump their patients onto new residents without bothering to fill them in on everything they need to know. So it might not be the residents, but the experienced doctors who are at fault. But in either case, you still "die in July".
In addition to inexperience, new residents famously suffer from unmanageable schedules and sleep deprivation. I've written before about the connection between physician fatigue and medical errors. As I've mentioned, a 2006 Harvard University study showed that doctors who worked even one extended, 24-hour shift during the month increased the odds of reporting a "significant medical error" by 300 percent. Those who completed five extended shifts reported 700 percent more significant errors and a 300 percent increase in errors that resulted in patient death. Although some hospitals have made efforts to reduce the 120 hours a week that new medical residents typically work, those reductions still have residents working 80 hours a week or more.
Given these ungodly schedules, one would expect to see plenty of mistakes, but Dr. Phillips reports that, according to his study, reduced schedules did not seem to reduce the number of errors that medical residents made. But the reduced schedules he referred to only capped the number of hours that medical students could work at 80 per week. Consider that an 80-hour a week schedule could, conceivably, include two 36-hour shifts or three 24-hour shifts, and you can see trouble coming.
Clearly, medical professionals need to be at least as well rested as say, hairdressers, accountants, lawyers, and others who don't literally take our lives in their hands. Capping physician schedules at 80 hours a week simply isn't sufficient to ensure that they will perform at their best. Plus, as the study authors wrote, "Our findings provide fresh evidence for re-evaluating responsibilities assigned to new residents; increasing supervision of new residents; and increasing education concerned with medication safety. Incorporating these changes might reduce both fatal and non-fatal medication errors and thereby reduce the substantial costs associated with these errors."
It's hardly comforting, but the head of the Association of American Medical Colleges, Dr. Joanne Conroy, gives another potential reason for the July spike. "Even though we associated July with new residents, actually there are a lot of new caregivers in July," she said. "It's probably a time where there are a lot of health professionals assuming new responsibilities. Everybody moves up."
As if you didn't already have plenty of good reasons to stay away from the hospital, at least try to stay healthy and accident-free in July. If for some reason, you do find yourself admitted to your local hospital in the heat of summer, make sure you check, double-check, and triple check every medication that comes your way, and line up an advocate now who will accompany you should you end up so ill that you have no choice but hospitalization…during any month.