The killing season has always been portrayed by doctors as a semi-amusing myth. Don’t, whatever you do, get admitted to hospital in August because if the illness doesn’t get you the new trainees - just out of medical school - will. Ha ha!
It has traditionally been a stressful time for registrars. Not only are they supervising juniors who don’t know one end of a cannula from the other, but often their bosses have also shoved off to Tuscany for a fortnight.
Though despite the odd lurid anecdote, there’s been very little evidence to suggest patients are really at risk during this change over.
That was, however, until now.
Last month, an Imperial College London study suggested that there was a small but statistically significant number of patients dying each year when junior doctors start work.
Researchers looked at 300,000 patients admitted as emergencies to English hospitals between 2000 and 2008. They compared death rates between the first week of August, when new doctors arrive, and the previous week in July.
They reported that the August patients were 6% more likely to die. The researchers might have stressed they were unable to draw firm conclusions about the reasons for the increase - but I’m going to take a wild stab in the dark and say that the instability of change over might have something to with it.
New international research backs this up. It finds that the rate of undesirable events in teaching hospitals increases at the beginning of the academic year. But, more interestingly, this is regardless of the level of clinical experience.
A team of international researchers examined whether patients having an anaesthetic procedure carried out by first to fifth year trainees at the beginning of the academic year had a higher rate of undesirable events than patients operated on later in the year.
Using data from a University affiliated hospital in Melbourne, Australia, the team analysed 19,560 patients over a period of five years. The rate of undesirable events was higher at the beginning of the academic year compared with the rest of the year. And this excess risk was seen for all trainees regardless of their level of clinical experience, suggesting that seniority of trainees does not protect patients from undesirable events.
So, it would seem that the doctoring newbies are off the hook. The killing season is not about technical skills. It clearly has more to do with an unfamiliar environment for trainees, a lack of supervision and inadequate communication.
The research authors call on hospitals to develop resilient systems in which individuals, teams, and their organisations can adapt and compensate for the disruptions of incoming inexperienced trainees. Better induction and integration, supervision and mentoring and team work.
The evidence suggests that the killing season joke really is starting to wear thin. It’s time for a proper response - only then will it really become a semi-amusing myth.
Read another blog on the killing season.
Tags: Change over, Training
