New docs linked to death spike in July

Are new medical residents a threat to patient health? According to sociology professor David Phillips and his student Gwendolyn Barker from the University of California, San Diego, fatal medication errors peak in July in counties with teaching hospitals, which coincides with the yearly influx of new medical residents who are given increased responsibility for patient care.

Their findings are published in the Journal of General Internal Medicine, the official journal of the Society of General Internal Medicine, published by Springer.

Phillips and Barker looked at the relationship between inexperience and medical error by focusing on changes in the number of medication mistakes (involving accidental overdose of a drug, wrong drug given or taken in error, drug taken inadvertently, and accidents in the use of drugs in medical and surgical procedures) in July, when thousands begin medical residencies. They tested the hypothesis that the arrival of new medical residents in July is associated with increased fatal medication errors.

They examined 244,388 U.S. death certificates issued between 1979 and 2006, focusing on fatal medication errors as the recorded primary cause of death. They compared the observed number of deaths in July with the number of expected events in a given month for a given year. They also looked at whether there were any differences between deaths in and out of hospitals in July as well as between counties with and without teaching hospitals.

The authors found that inside medical institutions, fatal medication errors spiked in July and in no other month. This July peak was visible only in counties with teaching hospitals. In these counties, the number of July deaths from medication errors was 10 percent above the expected level. No similar link was observed for other causes of death or for deaths outside hospitals.

The authors highlight several implications for medical policy. "Our findings," they write, "provide fresh evidence for 1) re-evaluating responsibilities assigned to new residents; 2) increasing supervision of new residents; 3) increasing education concerned with medication safety. Incorporating these changes might reduce both fatal and non-fatal medication errors and thereby reduce the substantial costs associated with these errors."