it has become a huge problem for persons coming down with illenss during summer months, as this is holiday time. doctors and nurses are off for the yearly vacations, leaving the hosp and patients in the hands of interns and newbies. when they are not gone vacationing, they sit around making phone calls and talking to fellow workers about the trips, cost, destinations, others experiences and suggestions. and the rest of the year they are caught up with trying to cash in on their "sick" days. if they are not used they do not carry over. so it is difficult to keep the same doctors or people who are familiar with your case around, leaving you to have to go thru expensive unnecessary proceedures because the new people are lost. it would be so much better if hosp staff could stagger their vactions so someone is running the store so to speak.l it frightens me, and has caused me extreme discomfort and fear. and sick days????? people can't get their medical bills paid for while the workers are off using up their deserved days off. what a shame.
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But other studies have not found a link between those early weeks of medical training and an increase in patient mortality. Huckman himself calls the 4 percent figure a little misleading. "If not for the turnover, these individuals might have survived hospitalization," he says. "But for people who die in hospitals, it's quite likely that they have a condition that's fairly serious to begin with. These are deaths that we observe that effectively occur earlier than they might otherwise occur. And when you look at it in respect to the other things that go on in hospitals that lead to patient mortality, I wouldn't say that this is a huge cost. It's important to put it in context."
Jay Bhattacharya, a professor at Stanford Medical School who also teaches on health care economics, says that up until the Harvard study, he considered the July phenomenon more medical myth than reality. Bhattacharya and others believe that the mistakes newbie doctors make by and large involve unnecessary tests and longer hospital stays, errors that aren't typically life-threatening. "But a lot of times, those kinds of things do snowball," he says. Bhattacharya says he "wouldn't paint an alarmist picture about it, but it's worth knowing."
Other research has found no increase in death rates during July. In a 2003 study, Doctors William A. Barry and Gary Rosenthal of the University of Iowa, looked at patient mortality rates in intensive care units and found no significant difference for the same period. "Fortunately, the results were boring," Dr. Rosenthal says. "What it suggests is that there's enough checks in the system that patients are not at undue risk. It's possible the attending physicians are a little more vigilant [in the summer]."
A bigger safety problem may be the routine patient handoffs that happen several times a day in hospitals. David Stevens, editor of Quality and Safety in Healthcare at the Dartmouth Center for Health Literacy, believes that the July turnover is just a large-scale example of those daily staff turnovers, which are also fraught with potential errors. At every shift change, doctors and nurses exchange information about each of their patients. These conversations are critical to patient care: they tell the incoming doctors what to look for, what's been observed and how to proceed. As one nurse explained it, a lot of that information is instinctive and can't be communicated through a chart.
"A huge gap occurs when you bring in a whole new cohort [of caregivers]," says Stevens. "But there's also a lot of micro-segments of that that occur. Every morning, every weekend, between when one cohort leaves and another comes on. These handoffs are a big deal in safety. We've only just begun to do it systematically." (The World Health Organization's Joint Commission on Patient Safety reports that gaps in communication at shift change can "cause serious breakdowns in the continuity of care, inappropriate treatment and potential harm for the patient." In 2007, the commission recommended standardizing handover procedures worldwide.)
The one element of continuity through both yearly and daily staff changes is the nursing staff. Most medical professionals will say that the RNs and LPNS are crucial to continuity of care and training. "Doctors rely on nurses, and there are a lot of nurses who have bailed out doctors on occasion," says Ann Williamson, Director of Nursing at the University of Iowa. But, according to Williamson, that doctor-nurse relationship is growing more strained in recent years. "There is more of a competitive drive," she says. "Some of the newer doctors coming out are embarrassed to rely on a nurse."
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