The July effect: an analysis of never events in the nationwide inpatient sample.
Approach to Improving Safety
Setting of Care
Whether the "July effect"—a period of increased risks due to the introduction of new interns and residents at hospitals—is a real phenomenon or merely a myth has been long debated. Prior studies have largely been mixed, although a systematic review concluded that the weight of the evidence suggests increased mortality during this annual workforce transition. This retrospective cohort study used the AHRQ-maintained nationwide inpatient sample database to examine hospital-acquired conditions, which are considered to be never events. Of the nearly 145 million admissions recorded across 4 years, hospital-acquired conditions occurred in 4.7% of hospitalizations overall, while patients admitted in July had an incidence of 4.9%. July admissions were linked to a 6% increased likelihood of experiencing a hospital-acquired condition, with multivariate analysis corrections. Hospital-acquired conditions, which represent preventable complications, are likely a more sensitive marker for hospital quality and safety than mortality. A prior AHRQ WebM&M commentary explored the implications of the July effect through discussing a case of iatrogenic hypoglycemia (a never event) related to a new intern's lack of experience.