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. 2019 Jan;20(1):157-162.
doi: 10.5811/westjem.2018.10.39885. Epub 2018 Nov 19.

July Phenomenon Impacts Efficiency of Emergency Care

Amit Bahl  1 , Catherine Cooley Hixson  2
Affiliations

July Phenomenon Impacts Efficiency of Emergency Care

Amit Bahl et al. West J Emerg Med. 2019 Jan.

Abstract

Introduction: The "July effect" describes the period in which new interns begin learning patient care while senior residents take on additional responsibility in an academic hospital setting. The annual change in staffing creates inefficiencies in patient care, which may negatively impact quality of care. Our objective was to evaluate the impact of the annual resident turnover on emergency department (ED) efficiency in a teaching hospital.

Methods: This was an institutional review board-approved retrospective chart review spanning two academic years analyzing 79,921 records. We grouped July and August into the period of least experience (PLE) and May and June into the period of most experience (PME). Outcomes included faculty and resident productivity, ED door-to-doctor time, and time to disposition.

Results: Patients were evaluated by 117 emergency residents and 73 emergency faculty. We excluded patient records for 35 off-service residents. Residents saw 15.8% more patients in the PME compared to the PLE (p<0.0001). The residents' average door-to-doctor time during the PLE was 45.63 minutes (standard deviation [SD] 33.01, median 36) compared to 34.69 minutes (SD 25.22, median 28) during the PME, with a decrease in time by 21.3% (p=0.0203). The residents' average time to disposition during the PLE was 304.6 minutes (SD 308, median 217) compared to 269.0 minutes (SD 282, median 194) during the PME, decreasing by 12.4% (p=0.0001). Residents had an average ED length of stay for discharged patients of 358.5 minutes (SD 374.6, median 238) during the PLE compared to 309.9 minutes (SD 346.4, median 209) during the PME, decreasing 13.7% for discharged patients (p=0.0017).

Conclusion: Annual turnover of resident staffing has a significant impact on common ED efficiency metrics. EDs should consider interventions to mitigate the impact of these expected inefficiencies.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Door to doctor interval for residents, faculty, and all physicians. PLE, period of least experience (July/August); PME, period of most experience (May/June).
Figure 2
Figure 2
Time to disposition interval for residents, faculty, and all physicians. PLE, period of least experience (July/August); PME, period of most experience (May/June).
See this image and copyright information in PMC

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