There is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August.
The figure below, for example, depicts real data for the whole of 1996 for a major acute hospital that was a key pilot site in the development of the NHS’s Incident Recording and Information System (IRIS) – part of the NHS’s Safecode project in the nineties. The trend, produced by the IRIS software, clearly shows a significant rise in reported harm to patients during August. Root cause analysis found that the major underlying cause related to lack of effective trainee doctor supervision whilst more senior doctors were on holiday.
This issue has now been subjected to a fairly rigorous scientific analysis and is the subject of a recently published paper by researchers at Imperial College London. The researchers investigated whether in-hospital mortality in hospitals in England is higher in the week following the first Wednesday in August than in the previous week
They found that “the odds of death for patients admitted on the first Wednesday in August was 6% higher after controlling for year, gender, age, socio-economic deprivation and co-morbidity. When subdivided into medical, surgical and neoplasm admissions, medical admissions admitted on the first Wednesday in August had an 8% higher odds of death.” In each case the results were statistically significant.
The researchers state that if this is due to the changeover of junior hospital staff, then this has potential implications not only for patient care, but for NHS management approaches to delivering safe care. They suggest further work to look at other measures such as patient safety, quality of care, process measures or medical chart review to identify preventable deaths rather than overall early mortality to further evaluate the effect of junior doctor changeover.
In their efforts to govern patient safety, Healthcare Governance Review believes that boards of hospitals with trainee doctors should be challenging executive directors on the safeguards (controls) in place to manage the potential risks.
Read the full research article Early In-Hospital Mortality following Trainee Doctors’ First Day at Work here.