July Effect of Medical Residents’ Care: No Adverse Stroke Outcomes

dr-gustavo-saposnikMedicalResearch.com Interview with:
Gustavo Saposnik, MD, MSc., FAHA, FRCPC

Director, Stroke Outcomes Research Center
Co-Director, Stroke Program – Research & Innovation
Associate Professor & Clinician Scientist
Departments of Medicine (Neurology) and
Health Policy, Management and Evaluation (HPME)
St. Michael’s Hospital University of Toronto

Medical Research: What is the background for this study? What are the main findings?

Dr. Saposnik: There is some controversy around worse outcomes at the beginning of academic year. Physicians recently graduated from medical schools begin their training and assume responsibilities for patient care in teaching hospitals, usually bearing the first-line duty for managing patients. Consequently, less experienced staff having new roles may influence access to care and contribute to adverse outcomes in patients managed at the beginning of academic year – the so-called “July Effect”. for example, increase of medication errors and in-hospital mortality in July has been reported from teaching hospitals.

In our large cohort study, comprising 10,319 stroke patients, 882 (8.5%) were admitted in July. Those patients were 28% less likely to receive thrombolysis (clot-buster treatment) (12% vs. 16%; odds ratio (OR), 0.72; 95% confidence interval (CI), 0.59-0.89) and 22% less likely to receive stroke unit care (62% vs. 68%; 0.78; 0.68-0.90). July admissions were not associated with either of higher death at 30 days (adjusted OR, 95% CI; 0.88, 0.74-1.03) or poor functional outcome (0.92, 0.74-1.14). Results remained consistent in the sensitivity analysis by including both July and August as part of the ‘July effect’.

Medical Research: What should clinicians and patients take away from your report?

Dr. Saposnik: The results of our study suggest that some variations exist in access to thrombolysis and stroke unit care for July admissions. However, these variations do not appear to impact on stroke outcomes. A multidisciplinary approach and teamwork would help ameliorate this transient phenomenon.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Saposnik: Further studies are needed to determine the underlying causes of the “july effect”. Comparisons of access to care and outcomes for sensitive medical conditions between a teamwork approach vs. care provided by a single physicians may shed light to this phenomenon.

Citation:

Academic Year-end Changeover and Stroke Outcomes

Park, Tai Hwan et al.

Journal of Stroke and Cerebrovascular Diseases
Published Online: December 23, 2014
DOI: http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.030

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