Cover of the British Medical Journal 10 October 2009. Photo: BMJ.com
In a paper [1] in the British Medical Journal published today, Haller et al. report that the overall rate at which adverse events occur at the beginning of the academic year is 137 per 1000 patient hours as compared with 107 per 1000 patient hours at other times. The likelihood of adverse events decreases steadily in the succeeding months and by the time four months have elapsed, the risk to patients has returned to baseline levels. Interestingly, the rate of adverse events is higher at the beginning of the academic year across all trainee doctors, irrespective of their level of seniority (i.e., experience) suggesting that there is something about a doctor commencing at a new hospital or in a new environment that leads them into error, rather than a simple lack of knowledge about medicine. Haller et al. suggest that it might be aspects of work such as unfamiliarity with the work environment and with hospital procedures, problems with teamwork in newly formed teams, and communcation problems that might be the root cause of the adverse events.
On the bright side, the results also suggest a solution to the problem of increased risk. Specifically, it might be sufficient to have new trainees spend more time getting to know the hospital routine before then take over responsibility for patients from the outgoing rotation of doctors.
References
[1] Haller, G., Myles, P.S., Taffé, P., Perneger, T.V., & Wu, C.L. (2009). Rate of undesirable events at beginning of academic year: retrospective cohort study. British Medical Journal, 339, b3974. doi: 10.1136/bmj.b3974
Contributors: Mark R. Diamond