A Deadly Month

The results of a new Journal of General Internal Medicine study that associates a 10% increase in medication-error-related deaths in teaching hospitals in July should not be ignored by hospitalists, says an associate residency program director.

Majid E. Cina, MD, FACP, a hospitalist and associate director at the University of Maryland School of Medicine in Baltimore, says the implication is that errors made by new medical interns are responsible for the spike, but HM leaders in academic settings shouldn’t draw too solid a conclusion. The spike could be tied to interns across a variety of departments, or the result of a series of other factors outside the scope of researchers.

“Correlations made by such studies are inherently flawed, with no certain cause-effect relationship established despite all attempts to control variables,” Dr. Cina says. “Still, these data cannot be ignored. … Program directors should take heed.”

Researchers reported that inside medical institutions, in counties containing teaching hospitals, fatal medication errors spiked 10% in July and in no other month (JR=1.10; [1.06-1.14]) (J Gen Intern Med. 2010 Aug;25(8):774-779). Counties without teaching hospitals in the region had no spikes, and the greater the concentration of teaching hospitals in a region, the greater the July spike (R=0.80; P=0.005).

“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,” the study authors wrote.

Dr. Cina says his institution prioritizes the care of patients in July. Additional staff is put in place at the beginning of internships, which start a week early to allow for a smooth transition period. Senior staff also work longer hours in July, in close contact with residents on “a steep learning curve,” he says. “I recognized my work days will be much longer in July,” Dr. Cina adds.

As an academic hospitalist, Dr. Cina noted that new rules proposed by the Accreditation Council for Graduate Medical Education (ACGME) to reduce resident work hours might help mitigate medication-error-related deaths. Those regulations could go into effect in July 2011.

 

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