The “July effect” refers to a drop in the quality of medical care due to trainees’ changeover at the beginning of academic year in July. Greater teaching team workload is associated with worse patient outcomes, but it is unknown if the association is the same in the early part of the academic year and the later months. To address this, we examined the associations between medical team workload, timing of admission during academic year, and 30day readmission rate.
In this retrospective observational study, we examined all admissions to the medicine teaching service of an urban academic medical center from 3/1/09 to 6/30/10. Admissions were divided into two groups based on the admission date during either first quarter of the academic year, or during the rest of the year. The two patient groups were compared with respect to demographic characteristics, comorbidities (Charlson score), severity of illness (Laboratorybased Acute Physiology Score, LAPS), and number of prior admissions. Admissions were further divided into groups as follows: those assigned to “busy” teams (total admissions >49) and those assigned to “less busy” teams (total admissions <=49). The primary outcome was 30day readmission rate. Multivariate logistic regression models were constructed to determine the independent association between teaching team workload and readmission rates, stratified by time of year of admission, after adjustment for demographic and clinical characteristics.
Of 12,118 admissions examined, 2,352 (19.4%) were admitted during the first quarter of the academic year (JulySeptember) and 9,766 (80.6%) were admitted during the rest of the year (OctoberJune). Patients admitted during the first quarter were similar to the patients admitted during the rest of the year with respect to age, gender, race/ethnicity, insurance, and clinical characteristics (LAPS and Charlson score). Patients admitted to busier teams in the first quartile had similar 30day readmission rate (15.26% vs 14.93%, Pvalue 0.82), but greater 30day readmission rate during the rest of academic year (17.3% vs 14%, Pvalue 0.04). After multivariate adjustment for age, LAPS, Charlson score, 90day prior admissions, patients admitted to morebusy versus lessbusy teams in the first quartile had similar 30day readmission rate (OR = 1.03 (0.821.30)). During the rest of the academic year admission to a busier team was associated with increased risk of readmission (OR = 1.16 (1.031.30)).
During the first quarter of the academic year admission to a busier team is not associated with increased odd of 30day readmission. In contrast, during the rest of academic year admission to busier teams is associated with 16% increased odds of 30day readmission.
Table 1Odds of 30Day Readmission if Admitted to More Versus Less Busy Team, Stratified by Time of Year
|First Quarter (JulySeptember)||1.03 (0.821.29)||1.03 (0.821.30)|
|Second to fourth Quarters (OctoberJune)||1.27 (1.141.41)||1.16 (1.031.30)|
|Adjusted for age, LAPS, Charlson score, 90day prior admissions.|
To cite this abstract:Southern W, Averbukh Y. An Association Between Timing of Admission, Medical Team Workload, and 30Day Readmission Rate. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97600. https://www.shmabstracts.com/abstract/an-association-between-timing-of-admission-medical-team-workload-and-30day-readmission-rate/. Accessed December 10, 2018.