ArticleThe western journal of emergency medicine2019
July Phenomenon Impacts Efficiency of Emergency Care.
Article in The western journal of emergency medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Comparing the preventive behavior of medical students and physicians in the era of COVID-19: Novel medical problems demand novel curricular interventions.Biochemistry and molecular biology education : a bimonthly publication of the International Union of Biochemistry and Molecular Biology · 2020Trial
- Factors that predict emergency department length of stay in analysis of national data.Clinical and experimental emergency medicine · 2025Article
- The mortality of patients with sepsis increases in the first month of a new academic year.Clinical and experimental emergency medicine · 2024Article
- The impact of resident training on robotic operative times: is there a July Effect?Journal of robotic surgery · 2024Article
- Exploring the 'January effect' at a university hospital in Pakistan: a retrospective cohort study investigating the impact of trainee turnover on patient care quality outcomes.BMC medical education · 2023Article
- Definitions and factors associated with emergency physician productivity: a scoping review.CJEM · 2023Article
- Residency Prep Course Instills Confidence in Interns.Kansas journal of medicine · 2021Article
- Surgical Residents' Proficiency and Turnover May Affect the Overall Efficiency in an Emergency Department.World journal of surgery · 2019Article
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe "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.
methodsThis 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.
resultsPatients 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<0.0001). The residents' average door-to-doctor time during the PLE was 45.63 minutes (standard deviation [SD] 33.01, median 36) compared to 34.69 minutes (SD 25.22, median 28) during the PME, with a decrease in time by 21.3% (p=0.0203). The residents' average time to disposition during the PLE was 304.6 minutes (SD 308, median 217) compared to 269.0 minutes (SD 282, median 194) during the PME, decreasing by 12.4% (p=0.0001). Residents had an average ED length of stay for discharged patients of 358.5 minutes (SD 374.6, median 238) during the PLE compared to 309.9 minutes (SD 346.4, median 209) during the PME, decreasing 13.7% for discharged patients (p=0.0017).
conclusionAnnual 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.
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