July Phenomenon Impacts Efficiency of Emergency Care.
West J Emerg Med
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
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.
Bahl A, Hixson CC. July Phenomenon Impacts Efficiency of Emergency Care. West J Emerg Med. 2019 Jan;20(1):157-162. doi: 10.5811/westjem.2018.10.39885. Epub 2018 Nov 19. PMID: 30643619; PMCID: PMC6324718.