Hospital visits more deadly in July, study finds

By Deborah Kotz, Globe Staff

The month patients enter a hospital could affect their risk of dying before they head home. A new review study published today in the Annals of Internal Medicine indicates that July -- when new residents, or doctors in training, start and old residents leave -- is the riskiest month.

Patients admitted to teaching hospitals in July are more likely to die, or experience prolonged hospital stays during the year-end changeover -- known as the July effect -- compared with other months of the year, according to researchers who reviewed data from 39 studies. The best-quality studies reviewed found that patients treated in July had a four to 12 percent increase in mortality risk compared to those treated in the spring before the staffing change.

Some of the studies also indicated an increase in medical errors and complications from procedures, but the data weren’t strong enough to draw firm conclusions.

The study also didn’t examine whether it was riskier to have outpatient procedures like knee surgeries or biopsies in July. “It is certainly one factor among many for a patient to consider when scheduling a truly elective procedure,” says study author Dr. John Young, a psychiatrist and associate director of the residency training program at the University of California, San Francisco Medical Center.

Unfortunately, there’s not much else a patient can do to minimize the July effect. “Anecdotally, we are aware of training programs that make concerted efforts to have the ‘best’ attending physicians on service in July or alter rounding practices to provide additional oversight for new physicians,” write the study authors.

While this might mitigate the changeover effect, it hasn’t yet been demonstrated in studies. Also not known: whether it’s less risky for patients to head to community hospitals in July -- which typically don’t use residents but may be short-staffed from doctors going on vacation -- than to head for a big academic teaching hospital.

Patients can also request that a senior resident be present for any procedure performed on them by a first-year intern. And, yes, they do have the right to know whether the physician treating them has barely begun training, according to the American Hospital Association. Check out the AHA patient bill of rights.