A new study from researchers at the University of California at San Diego and Los Angeles suggests that a sharp uptick in fatal medication mistakes in July corresponds with the entry of thousands of trainee doctors into medical residency programs across the U.S.
The study, published in the June issue of the Journal of General Internal Medicine, analyzed all U.S. death certificates from 1979 to 2006. Researchers David Phillips and Gwendolyn Barker found that, in counties with teaching hospitals, on average deadly medication mistakes surged by 10% each July. Phillips and Barker also noted that areas with higher concentrations of teaching hospitals tended to have higher increases in fatal medication errors. No similar jump was seen in counties without medical residency programs.
The authors say that the “July Effect” was limited to medication mistakes, and did not correspond to other types of medical errors or causes of death, including deaths that occurred outside of medical institutions. As Phillips and Barker sum up:
“After assessing competing explanations, we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.”
The researchers say that their investigation was limited by the fact that they were only analyzing the most severe outcomes of medical mistakes, and that the death certificates provided little detail about the specific circumstances of each mortality. Additionally, they question why fatal medication mistakes surged during July in areas with teaching hospitals, while other types of medical errors — such as surgical mistakes — did not. Still, the authors argue that their analysis of more than 62 million death certificates from nearly three decades points to “a significant public health problem,” and warrants further investigation.
Based on the current findings, Phillips and Barker suggest that three simple steps be taken to diminish any additional risk to patients as new medical residents enter training programs in mid-summer: a re-evaluation of intern responsibilities, increased supervision by more experienced physicians and a greater emphasis on safety when dosing medication.