July Phenomenon Impacts Efficiency of Emergency Care

The "July effect" describes the period in which new interns begin learning patient care while senior residents take on additional responsibility in an academic hospital setting. The annual change in staffing creates inefficiencies in patient care, which may negatively impact quality of care. Our objective was to evaluate the impact of the annual resident turnover on emergency department (ED) efficiency in a teaching hospital.

This was an institutional review board-approved retrospective chart review spanning two academic years analyzing 79,921 records. We grouped July and August into the period of least experience (PLE) and May and June into the period of most experience (PME). Outcomes included faculty and resident productivity, ED door-to-doctor time, and time to disposition.

Patients were evaluated by 117 emergency residents and 73 emergency faculty. We excluded patient records for 35 off-service residents. Residents saw 15.8% more patients in the PME compared to the PLE (p<0.0001). The residents' average door-to-doctor time during the PLE was 45.63 minutes (standard deviation [SD] 33.01, median 36) compared to 34.69 minutes (SD 25.22, median 28) during the PME, with a decrease in time by 21.3% (p=0.0203). The residents' average time to disposition during the PLE was 304.6 minutes (SD 308, median 217) compared to 269.0 minutes (SD 282, median 194) during the PME, decreasing by 12.4% (p=0.0001). Residents had an average ED length of stay for discharged patients of 358.5 minutes (SD 374.6, median 238) during the PLE compared to 309.9 minutes (SD 346.4, median 209) during the PME, decreasing 13.7% for discharged patients (p=0.0017).

Annual turnover of resident staffing has a significant impact on common ED efficiency metrics. EDs should consider interventions to mitigate the impact of these expected inefficiencies.