Inaba Kenji, Recinos Gustavo, Teixeira Pedro G R, Barmparas Galinos, Talving Peep, Salim Ali, Brown Carlos, Rhee Peter, Demetriades Demetrios
Division of Trauma Surgery and Surgical Critical Care, Los Angeles County + University of Southern California Medical Center, Los Angeles, California, USA.
J Trauma. 2010 Jan;68(1):19-22. doi: 10.1097/TA.0b013e3181b88dfe.
The "July Phenomenon" refers to the propensity for increased errors to occur with new housestaff, as they assume new responsibilities at the beginning of the academic year. The purpose of this study was to examine the impact of the new residents presenting in July at a high volume Level I Academic Trauma Center.
The trauma registry at the Los Angeles County + University of Southern California Medical center was retrospectively reviewed to identify all injured patients admitted over a 5-year period ending in December 2006. All Morbidity and Mortality reports for the study period were reviewed to extract deaths and any complications classified as preventable or potentially preventable. Patients admitted in the first 2 months (July to August) of the academic year were compared with those treated at the end of the academic year (May to June). Baseline clinical and demographic characteristics were compared, and the rates of preventable and potentially preventable deaths and complications were determined for each of these groups.
During the 5-year study period, 24,302 injured patients were admitted. Of those, 8,151 were admitted during the period from May to August with 4,030 (49.4%) at the beginning of the academic year (July to August) and 4,121 (50.6%) at the end of the academic year (May to June). Overall, the average age was 35.1 +/- 17.7 years, 77% were men with an Injury Severity Score of 8.4 +/- 9.7 and 24.2% penetrating injury rate. When examining mortality, after adjustment for differences between the two groups, there was no difference between patients admitted at the beginning or at the end of the academic year (adjusted odds ratio [95% confidence interval]: 1.1 [0.8, 1.5], p = 0.52). However, when compared with the patients treated for their injuries in May to June, those treated at the beginning of the academic year had a significantly higher rate of preventable and potentially preventable complications (adjusted odds ratio [95% confidence interval]: 1.9 [1.1, 3.2], p = 0.013).
At an academic Level I trauma center, admission at the beginning of the academic year was associated with an increased risk of errors resulting in preventable and potentially preventable complications; however, these errors did not impact mortality. Specific errors associated with this increased rate of preventable complications warrant further investigation.
“七月现象”指的是新入职住院医师在学年开始承担新职责时出现错误增多的倾向。本研究的目的是调查七月新入职住院医师大量涌入对一所一级学术创伤中心造成的影响。
对洛杉矶县+南加州大学医学中心的创伤登记处进行回顾性审查，以确定在2006年12月结束的5年期间内收治的所有受伤患者。审查研究期间所有的死亡和发病率报告，提取死亡病例以及所有归类为可预防或潜在可预防的并发症。将学年前两个月（7月至8月）收治的患者与学年末（5月至6月）接受治疗的患者进行比较。比较两组患者的基线临床和人口统计学特征，并确定每组可预防和潜在可预防的死亡及并发症发生率。
在5年研究期间，共收治24302例受伤患者。其中，8151例在5月至8月期间入院，4030例（49.4%）在学年开始时（7月至8月）入院，4121例（50.6%）在学年末（5月至6月）入院。总体而言，患者平均年龄为35.1±17.7岁，77%为男性，损伤严重程度评分为8.4±9.7，穿透伤发生率为24.2%。在研究死亡率时，对两组之间的差异进行调整后，学年开始时入院的患者与学年结束时入院的患者之间没有差异（调整后的优势比[95%置信区间]：1.1[0.8,1.5]，p=0.52）。然而，与5月至6月接受治疗的患者相比，学年开始时接受治疗的患者可预防和潜在可预防并发症的发生率显著更高（调整后的优势比[95%置信区间]：1.9[1.1,3.2]，p=0.013）。
在一所一级学术创伤中心，学年开始时收治患者与导致可预防和潜在可预防并发症的错误风险增加相关；然而，这些错误并未影响死亡率。与可预防并发症发生率增加相关的具体错误值得进一步调查。
