The so-called July phenomenon, in which errors are supposedly more common in July due to an influx of inexperienced residents and students, has long been a source of gallows humor in hospitals. Although prior studies have reached mixed conclusions, this Australian study of anesthesia errors did find a significant increase in preventable adverse events for procedures performed by trainees during the first 4 months of the academic year. Interestingly, error rates were higher for trainees at all levels, not just first-year residents. This finding implies that underlying systems issues as well as clinical inexperience resulted in adverse events. An accompanying editorial calls for revising training models in order to provide adequate supervision and support for new trainees. A case of inadvertent hypoglycemia resulting from an intern's lack of familiarity with insulin ordering at his new hospital is discussed in an AHRQ WebM&M commentary.

The author examined the varying interpretations of Reason's Swiss cheese model and found considerable variation among health care professionals.

The authors surveyed adults recently discharged from a Swiss hospital and found that patients can effectively pinpoint in-hospital adverse events.

Hand hygiene is an important practice that prevents transmission of infections. This cross-sectional study directly observed and surveyed more than 160 physicians at a large university hospital to describe current practices and beliefs. Investigators discovered that adherence to hand hygiene averaged only 57% with wide variations across medical specialties. Whereas being a role model, having a positive attitude towards hand hygiene, and easy access to hand-rub solutions was associated with adherence, high workload and activities associated with high risk for transmission were risk factors for poor adherence. The authors discuss the challenges with promoting effective hand hygiene practices and suggest targeting high risk settings and reinforcing individual’s abilities to role model behaviors. The U.S Centers for Disease Control and Prevention provides guidelines, fact sheets, a press kit, and other tools to implement best practices.