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How the Calendar and Time of Day Affect Hospital Medical Mistakes

Holidays, Weekends, Nightime, and the Reasons to Avoid Them in the Hospital


Updated November 07, 2013

We often distinguish medical errors by the types of errors they are, such as surgical mistakes, or prescription errors or hospital acquired infections. But there is another way to categorize medical errors. That is, the likelihood that medical mistakes are made more frequently during certain times of the year, even certain times of day. Following is a sense of how the calendar and time of day may negatively affect your chances of being the victim of a hospital medical mistake.

Holidays and General Vacation Times

Just like you work at your job and like to take a few days or a few weeks of vacation each year, so do healthcare workers. And just like the rest of us, there are certain dates on the calendar we prefer to take: holidays, weekends and summer vacation periods.

The problem is that regular staff, those full time workers who are the highest ranking employees in the hospital, are usually the people who get to choose their vacation times first. And what dates do they choose? The same times we would choose if we could: Thanksgiving, December holidays like Christmas or Hannukah, Easter and our children's school spring or winter break periods, the 4th of July, summer weeks, and those long weekends like Memorial Day, Labor Day, Columbus Day and others.

Weekends can be just as problematic. Those higher ranking, often more highly skilled personnel want their weekends off, too. As a result, hospital patient care is managed by those with less seniority, part time staff, temporary staff and others who are there to fill in.

Evenings -- same thing. Once evening rolls around, and daytime personnel goes home, there aren't as many healthcare professionals in the hospital to address problems that might crop up. Night Shift Nightmare, an article published in Reader's Digest in July 2007, tells numerous stories, and describes several studies about nightime tragedies in hospitals, all attributed to this overnight phenomenon. Higher rates of death for babies born at night, higher rates of death for night time heart attacks, higher incidents of medication errors and more are included.

(Please note - this is not intended to declare that any hospital personnel working during these off hours aren't capable of providing safe hospital care, nor is it intended to dun their skills. It's simply a statement of reality as to who is working in the hospital during what times.)

The July Effect

Medical school students graduate from their first four years of medical education, usually in Spring each year. At this point, they are officially considered to be doctors and they become teaching hospital residents to further their educations. They begin their new jobs in teaching hospitals in July.

At the same time these new residents are starting their new jobs, directly treating patients for the first time on their own, the longer-term staff, those experienced doctors, nurses and other hands-on medical employees, are beginning their summer vacations. Add that to the 4th of July holiday (see Holidays, below) and July becomes the perfect storm of opportunities for mistakes to be made on patients.

A study published in the Journal of General Internal Medicine in 2010 showcased the July Effect very clearly. They examined more than 62 million death certificates issued in the United States between 1979 and 2006, and noted all death certificates where the cause of death was attributed to prescription drug errors made during a hospital stay.

Their conclusions were astonishing. In the counties that housed a teaching hospital (an academic medical center), medication errors spiked significantly in July. In counties that were not served by a teaching hospital, the error rates remained the same. Further, in areas that had a higher concentration of academic medical institutions, the rates of death from medication mistakes in July were even higher.

Interestingly, the same could not be said of the rates of surgical errors, which did not rise in July in teaching hospitals or other hospitals. One reason could be the fact that new residents don't immediately begin performing surgery, like they do begin prescribing drugs. The teaching approach for residents is to ease into activities like surgeries, tests or procedures, so they may not be performing those in July at all.

As smart patients, we'll want to avoid teaching hospitals in July if possible. Few patients are hospitalized that don't receive some sort of drug prescription while they are there, putting all of us at risk if we are hospitalized in an academic hospital in July.


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