Hospitals’ rate of care slow in July

There is an old saying among doctors: “Don’t get sick in July.”
As new medical interns begin work at hospitals across Minnesota this month, many hospitals’ pace of care slows down in a phenomenon referred to by many in the medical community as the “July Effect.”
Doctors and interns at Twin Cities teaching hospitals including Hennepin County Medical Center , Abbott Northwestern Hospital and the University of Minnesota Medical Center, said the “July Effect” does exist, but its impact is minimized by the close supervision of veteran staff.
“There is a pretty big safety net,” said William Browne, Program Director, Internal Medicine Residency Program at the University of Minnesota. He said multiple layers of supervision include residents overseeing medical students, attending physicians watching over both residents and interns, and the nursing staff double checking orders.
However, in striving to maintain the usual quality of care, the rate that patients receive it slows.
“It almost takes me twice as long, because I will look up things two, three, four times just to be sure,” said Misty Retzlaff, an intern at the University of Minnesota.
“The residents are all very knowledgeable, but they are not very efficient,” said Louis Ling, associate medical director for medical education at Hennepin County Medical Center and associate dean for medical education at the University of Minnesota .
He said the best way for new residents to learn multi-tasking “is being a waiter or a waitress and having to handle a bunch of tables.”
He compared patients in July to customers at a restaurant, “orders are still right, they get their food, it’s the right food, it’s just that you might not get to them quickly enough and say ‘Oh, how are things going?’ ”
“Patients probably don’t get feedback they would like to have, or they would get at other times of the year,” Ling said.
Interns may not be checking in with patients as often, but they double-check uncertainties with medical staff frequently.
“Anything that I am remotely questioning I will ask,” Retzlaff said.
Even in the middle of the night “there is an attending physician and there is also a supervising resident that we can also call … they pretty much say if you have questions don’t hesitate to ask,” Brandon Anderson, an intern at the University of Minnesota , said.
“There [are] some departments that will actually beef up their staffing … they might have an extra chief resident,” said Ling.
Although most Minnesota hospitals do not have a policy that increases hours or minimizes vacation time of experienced staff in July, “people are a little bit more vigilant,” Bob Miner, internal medicine program director for Abbott Northwestern , said.
A study conducted by Harvard researchers and published by the National Bureau of Economic Research showed that from 1993-2001, in 700 teaching hospitals across the United States, the average length of stay increased by 2 percent and average mortality increased by 4 percent following the change of staff. This equaled 1,500 to 2,750 additional deaths each year.
Miner said that kind of study has not been conducted at Abbott Northwestern and that “some hospitals overall have shown that … my feeling is that’s probably not true here.”
There may be other factors involved in the increased deaths, Ling said. He cited drinking-related injuries as a possible cause, “in the summertime there is just more alcohol.”