Six Percent Increase in English Hospital Mortality Rates In August With New Interns

[steven johnson]

Practice makes perfect.

In the book Outliers: The Story of Success, Malcolm Gladwell studied the “outliers” – i.e., the most successful people of the world, including sportsmen, business people, musicians and scientists, to understand key factors behind their success. He found the key denominator to all their success isn’t natural aptitude as many like to believe. Having a high IQ doesn’t guarantee success : There is supposedly no difference with in the people’s propensity to success beyond an IQ of 130.

The key denominator is actually hard work. A lot of it, in fact. About 10,000 hours of it. That’s roughly 3 hours every day, for 10 consecutive years, before any one of them began to be defined as the ‘expert’ in their field.

A physician in a four-year residency working 80 hours per week with one month off a year works a total of 15,360 hours. Medicine tends to be a team sport with interns being assisted by senior house staff. So presumably the senior residents must reach a threshold where they can keep the interns from contributing to excess mortality some time during the first year of the interns' practice.

ScienceDaily (Sep. 23, 2009) — People admitted to English hospitals in an emergency on the first Wednesday in August have, on average, a six percent higher mortality rate than people admitted on the previous Wednesday, according to research published in PLoS ONE.

Newly qualified junior doctors start their new positions in NHS hospitals in England on the first Wednesday in August. The authors of the study, from the Dr Foster Unit and the Department of Acute Medicine at Imperial College London, say the excess mortality rates may be linked to this influx of newly qualified doctors but more research is needed before they can draw any firm conclusions.

Mortality rates fluctuate throughout the year, with higher rates in the winter. However, the researchers behind today's study suggest that although the effect identified in their research is small, it is statistically significant and there appears to be a relatively consistent pattern over the nine years of the study.

The researchers found a small, non-significant difference in the mortality rate using these figures. However, after taking into account factors such as age, sex, socio-economic deprivation, year and additional diagnoses, they found a six percent increase in mortality rates for the first Wednesday in August compared to the previous Wednesday.

Small Increase In Hospital Mortality Rates In First Week Of August, Research Shows

[supernova]

1. So, try not to be hospitalized in August

I wonder if there's a pattern of some common mistakes that the newbies are making. Not realizing a patient is about to code, for example?

Perhaps the study says, but the article doesn't

[Heddi]

2. I can tell you that as an RN, we *hate* July (that's when our interns start)

On a normal day, we (Nurses) have to be the second set of eyes and brains for MD's, pharmacy, nurse techs...we are ultimately responsible for the orders everyone else writes, the medications that everyone else puts in the bin, the vital signs that everyone else takes.

However, in the teaching hospitals I've worked in, July is when our Interns and Residents start and I've known MANY RN's who love nothing more than holding onto vacation pay and taking off the majority of that month.

I mean, think about it. You have someone who was in Med School in May, with basically no hands on, bedside patient care suddenly being a "doctor" in July. Yes, they have fellows and residents and MD's that follow them, but THEY are the ones who see the pt in the ER and follow them to the floor and eventually discharge them. As a RN that's overwhelming, I imagine even more so for an MD.

As a RN, I have the extra added duty of not only getting 4+ pages of order for something that should have, at most, 1/3 page of orders, but I have to go through each of those orders and make sure they're appropriate. These MD's are going "by the book" and ordering every lab in the world, every xray in the world, because they don't have enough experience to know what is and what isn't appropriate. It's a CYA thing. But it doesn't always work....some are so attached to their little book of lab and radiology tests that they don't think about the disease or disorder or problem with the patient and order things that are totally unnecessary, or order things that are completly inappropriate.

So not only is my night spent doing the 10,000 things I have to do just on a regular night, but I have to add at least 2-4 hours EXTRA per Resident Patient going through orders and making sure that they ordered the right thing (many a time I've called someone at 2am to have them order the very essential test they should have ordered, but didn't), and making sure their erroneous orders are cancelled (and in that same 2am phone call got possibly lethal orders cancelled).

I'm not saying that I know more than an MD, or that new MD's are stupid or anything. But they're new. Just like a new RN is overwhelmed with taking 5+ patients the first time, a new MD can be overwhelemed having 75 patients for the first time. So they need a good support system, but I think inherently they have to work rather independently from the start.

Oh and they take FOR-EV-ER with the f'ing chart. Admitted a patient last night at 7pm, couldn't do a bloody thing until after 10pm because the resident was hogging the chart. The woman was in for Chest Pain, Rule Out MI (Myocardial infarction--heart attack). She had pretty much BEEN ruled out for cardiac, and it was looking more and more like this was GERD or some other stomach issue. This is VERY common, and not a big deal.

Generally, we'll do some lab work every 6 or 8 hours to make sure the heart is okay, possibly not have them eat after midnight for some cardiac tests in the morning, and have nitroglycerine and morphine on hand for chest pain. VERY standard orders.

This guy, god bless his heart, wrote FOUR pages of orders. Wanted every lab under the sun done, including tests for Swine Flu, Avian Flu, a CAT scan of the brain (why???), medicine that people with liver disease get...it was like he was ordering EVERY. SINGLE> THING he had in his cabinet. It was insane. So I spent 3 hours not being able to do a thing for the woman b/c he had the chart, and another 2 hours going over line by line of orders figuring out what he really wanted. And he was repeating tests that were done in the ER---yes, I know she got an MRI 2 hours ago.I want another one. WTF? Seriously? NO. The woman is NOT going to get another MRI just b/c MRI shows up in your little book of diagnostic tests.....So after I went over these orders with the resident and was told YES YES YES to ever order, I had to call up his attending MD and get the orders rescinded because the resident wouldn't cancel them. It was an awful waste of time.


New Doctors---can't live with 'em, get your nursing license suspended if you kill them :D

[LeftishBrit]

3. My family has always said, "Never go into hospital in August or at Christmas if you have the choice"

A neighbour died from complications from an operation in August, and it was thought that if senior people had not been away, he might have been saved. A friend had serious complications (but fortunately recovered) after undergoing a procedure at a hospital that was understaffed at Christmas time. Both events occurred in small hospitals in the 1970s, and might have been less likely in a larger hospital now; but as the article shows, the problem hasn't disappeard.