Preparing for the July Effect: Five Strategies for Integrating New Residents

Deaths from medication errors appear to increase in July, perhaps because of the addition of new and inexperienced residents in that month, according to a new study.

Dubbed the "July effect," the phenomenon has been observed anecdotally, but David P. Phillips, PhD, of the University of California San Diego and Gwendolyn E.C. Barker, BA, of the University of California Los Angeles, looked at more than 62 million death certificates from 1979 to 2006 to find a pattern.

They observed that in counties with teaching hospitals, fatal medication errors rose 10% in July, and the greater the concentration of teaching hospitals in a county, the higher the spike in deaths. However, the death rate returned to normal after July, suggesting that residents learn quickly after the initial month.

But for teaching hospitals, even a short one-month spike in deaths from errors is a major quality challenge. Many hospitals have implemented policies in the past five years to better integrate new healthcare professionals and prevent the July effect, says Joanne M. Conroy, MD, chief health care officer at the Association of American Medical Colleges.

Successful strategies include the following:

Start with orientation. The quality team—including risk managers and quality and safety officers—should be involved in the orientation process for new residents, says Conroy.

Build a culture of safety. The orientation process is an early opportunity to begin ingraining new residents with the culture of the hospital. "Start them on the right foot by reviewing the quality goals of the organization and how important these are for good patient care," says Conroy. "Make sure they know who to call if there is a question and that they understand the ‘culture of safety’ at your institution."

Teach teamwork. New residents should always wear their name badges and introduce themselves to other members of the care team, especially nonphysician members, before they start. Teamwork is key to hospital safety, and effective communication early on facilitates the team-building process. "Emphasize that it takes teams of providers to care for the complicated medical conditions we see in teaching hospitals. They are an important contributor, but they are not in it alone, and there is no shame in asking for help," says Conroy.

Emphasize infection control. Simple infection control techniques like regular hand washing have proven challenging for even seasoned providers, so it's important to start emphasizing these procedures early in the residency.

Train with technology. The orientation process should include a thorough training on how to use the electronic health record and e-ordering systems.

In addition to increasing education and training related to medication safety, the researchers also recommended re-evaluating responsibilities assigned to new residents and providing more supervision when they start.