June 02, 2010
Teaching Hospital Deaths Peak In July

Each new crop of medical residents should be avoided.

Are new medical residents a threat to patients? According to Dr. David Phillips and Gwendolyn Barker from the University of California, San Diego in the US, fatal medication errors peak in July in teaching hospitals in particular, which coincides with the yearly influx of new medical residents who are given increased responsibility for patient care. Their findings1 are published in the Journal of General Internal Medicine, published by Springer.

If you are thinking about elective surgery then try to avoid July - at least at a teaching hospital.

They examined 244,388 US death certificates focusing on fatal medication errors as the recorded primary cause of death, issued between 1979 and 2006. They compared the observed number of deaths in July with the number of expected events in a given month for a given year. They also looked at whether there were any differences between deaths in and out of hospital in July as well as between counties with and without teaching hospitals

The authors found that inside medical institutions, fatal medication errors spiked in July and in no other month. This July peak was visible only in counties with teaching hospitals. In these counties, the number of July deaths from medication errors was 10 percent above the expected level. No similar link was observed for other causes of death or for deaths outside hospitals.

The medical profession needs to step up on the issue of quality control. Statistical process control, continuous improvement, root cause analysis, and the rest of the quality improvement techniques pioneered by the likes of W. Edwards Deming (one of my heroes) need to find a central place in how medicine gets done. Traditions like a huge turn-over in medical residents all in a single month need to be reexamined in light of the idea that fatal medical errors should be extremely rare. A 10% boost in death from medical errors in a single month due to an obvious cause should have been measured and detected many years ago.

While I'm at it: Medical residents forced to work long hours make more mistakes. Why is this still a problem in 2010? They also get into more car accidents. Hospitals falsify records in order to under-report resident hours worked. Beware.

Share |      Randall Parker, 2010 June 02 09:41 PM  Policy Medical

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