A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents
A July Spike in Fatal Medication Errors: A Possible Effect of New Medical Residents
复制标题
DOI：
10.1007/s11606-010-1356-3
复制
发表时间：
2010-08-01
影响因子：
5.7
通讯作者：
Barker, Gwendolyn E. C.
中科院分区：
文献类型：
--
作者：
Phillips, David P.;Barker, Gwendolyn E. C.
每年七月，成千上万的人开始住院实习，并承担起更多的患者护理责任。许多人认为，这些新的住院医师可能会产生错误并恶化患者的治疗效果，即所谓的“七月效应”；然而，我们没有发现美国证据证明这种影响。确定致命的用药错误是否在 7 月份激增。我们检查了 1979-2006 年所有美国死亡证明（n = 62,338,584），重点关注用药错误（n = 244,388）。我们将 7 月份观察到的死亡人数与通过最小二乘回归技术确定的预期人数进行了比较。我们比较了医疗机构内部和外部的七月效应。我们还比较了有教学医院和没有教学医院的县的 7 月效应。JR = 观察到的 7 月死亡人数 / 预期的 7 月死亡人数。在医疗机构内部，在有教学医院的县，致命用药错误在 7 月份激增 10%，其他任何月份都没有[JR = 1.10 (1.06-1.14)]。相比之下，没有教学医院的县 7 月份没有出现峰值。一个地区的教学医院越集中，7 月份的峰值就越大（r = .80；P = .005）。这些发现仅适用于用药错误，不适用于其他死亡原因。我们发现医疗机构内的致命用药错误在 7 月份显着激增。在评估了相互竞争的解释后，我们得出的结论是，7 月份死亡率飙升至少部分是由于新住院医师到来带来的变化造成的。
Each July thousands begin medical residencies and acquire increased responsibility for patient care. Many have suggested that these new medical residents may produce errors and worsen patient outcomes-the so-called "July Effect;" however, we have found no U.S. evidence documenting this effect.Determine whether fatal medication errors spike in July.We examined all U.S. death certificates, 1979-2006 (n = 62,338,584), focusing on medication errors (n = 244,388). We compared the observed number of deaths in July with the number expected, determined by least-squares regression techniques. We compared the July Effect inside versus outside medical institutions. We also compared the July Effect in counties with versus without teaching hospitals.JR = Observed number of July deaths / Expected number of July deaths.Inside medical institutions, in counties containing teaching hospitals, fatal medication errors spiked by 10% in July and in no other month [JR = 1.10 (1.06-1.14)]. In contrast, there was no July spike in counties without teaching hospitals. The greater the concentration of teaching hospitals in a region, the greater the July spike (r = .80; P = .005). These findings held only for medication errors, not for other causes of death.We found a significant July spike in fatal medication errors inside medical institutions. After assessing competing explanations, we concluded that the July mortality spike results at least partly from changes associated with the arrival of new medical residents.