July has been implicated as a time of increased medical errors because of its association with the onset of residency training. The abrupt transfer of patient care responsibilities at the beginning of each academic year has also been implicated as a potentially unsafe transition practice. Although both the question of patient safety at the beginning of each academic year and the specific link to new residents have not been proven, there are even fewer data to invoke a beneficial effect on patient care of new intern matriculation.
A quality improvement effort that aimed to increase rates of compliance with asthma core measures (specifically the Home Management Plan of Care, or Asthma Action Plan) initially noted a positive effect in association with a new class of interns in 2009. Interns complete the vast majority of action plans, and efforts were made to uniformly educate the new residents. The beginning of academic year 2009 was also used to initiate an effort that aimed to improve discharge communication to primary care physicians (PCPs). Residents had previously not been responsible for the most discharge dictations because of the perception that they would be unable to complete the tasks in a timely and reliable manner. The new class was asked to dictate the majority of summaries (formatted as letters) on the day of discharge.
Both quality improvement initiatives demonstrated a reduction in process variability and a transformation toward higher reliability when education of the new process coincided with a new class of interns. Specifically, after July 2009, rates of Asthma Action Plan completion increased from a median of 76% to greater than 90%. Data on timeliness of discharge letter communication were not routinely collected before September 2009 (education commenced July 2009), and there was early variability in rates. As attendings were instructed on a way to electronically verify completion of dictation, allowing for timely feedback to residents, by early 2010, 90% of discharge letters were faxed to PCPs within 2 days of patient discharge, and 85% of these letters were regularly dictated by residents (the majority of whom were interns).
Concerns about a “July effect” may be warranted; however, the effect may be a beneficial one on quality, highly reliable care. The beginning of the academic year presents a unique opportunity to educate a new class of interns. As interns absorb these duties and begin to teach each other, there exists an opportunity to change the culture with respect to tasks that have previously been considered of marginal importance in their daily work flow.
M. Shen ‐ none; L. Thoreson ‐ none; T. Wakefield ‐ none; D. Williams ‐ none; M. Iyer ‐ none
To cite this abstract:Shen M, Thoreson L, Wakefield T, Williams D, Iyer M. New Interns Drive Transformation Toward High Reliability: Viewing July As a Glass Half Full. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 206. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/new-interns-drive-transformation-toward-high-reliability-viewing-july-as-a-glass-half-full/. Accessed November 16, 2019.