The ‘July Phenomenon’: Experience at a Community Teaching Hospital

Stephen Jones, MD, Peter DeVito, MD, FACS. Northside Medical Center.

Introduction: The July Phenomenon term implies a perceived association between introduction of new graduates into the healthcare team and increased risk of complications. Numerous studies have focused on resident fatigue and operative safety, but none have clearly addressed the “July phenomenon”. The purpose of this study is to demonstrate the relationship of morbidity and mortality comparing surgeries performed at the beginning of the academic year (July) with the end of the academic year (May).

Methods: A retrospective chart review was undertaken to identify patients who underwent surgery by Board Certified Surgeons with resident assistance classified by The ICD-9-CM coding system. A list was compiled of General, Vascular, and Thoracic surgeries in May and July 2008-2012 respectively. Outcome measures were morbidity and mortality rates using a modifiedClavien-Dindo Classification schema of surgical adverse events

Results: A total of 634 patients had surgery of which 329 and 305 had procedures in May and in July respectively. 40 patients (12.2%) had an adverse event in July, whereas 28 patients (8.5%) had an adverse event in May (p=0.0001). 18 deaths (2.3%) were identified of which 6 (33.3%) occurred in May and 12 (66.6%) occurred in July (p=0.0001). July had significantly higher morbidity and mortality rates as compared to May 2008-2012.

Conclusion: Higher morbidity and mortality rates were observed in July compared to the end of the academic year consistent with the "July Phenomenon". Although, adequate attending supervision is perceived in our institution a quality improvement plan is being implemented to reduce the rates of complications related to the "July Phenomenon".

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