Errant fireworks and mosquito attacks are not the only threats in July. Two months ago, a study by UC San Diego researchers reported a 10 percent increase nationally in medication errors that killed patients during the month of July. This may seem inexplicable but for the fact that July is the traditional start date for new residents. The spike is prominent in counties with teaching hospitals, and is not repeated in any other month. The analysis was based on more than two decades of death certificate information
National medical research increasingly highlights the threat posed to patients by poor supervision of doctors-in-training at teaching hospitals. Dangers are compounded by the long shifts required of residents.
A 2005 study published in the Archives of Internal Medicine, looked at nearly 700 residents from about 40 clinical areas at two Harvard teaching hospitals. About half of the residents reported treating patients who suffered “adverse events,” or complications. When those residents were asked whether they caused the error, roughly one-fourth said yes.
Most complications were considered significant. Inadequate supervision was often cited as a contributing factor, researchers said.
Two years later, another study in the Archives analyzed data from nearly 900 malpractice claims and found 240 in which residents “played an important role in harmful errors.” The mistakes arose in more than 20 clinical areas and, and for most patients, the errors caused “significant” or “major” physical harm or death. The 2007 report also noted that poor supervision, either by faculty physicians or upper-level residents, accounted for over half of the cases of resident error.
Congress responded to the growing research connecting residents to high errors numbers by requesting a study of the state of medical residencies nationwide. The 2008 report by the Institute of Medicine urged that residency programs have “measurable standards,” such as when and how residents consult faculty doctors so that “programs provide adequate, direct, onsite supervision.” The institute is the medical research arm of the National Academy of Sciences, which advises the federal government.
The Association of American Medical Colleges supported the institute’s recommendations. And this summer, the Accreditation Council for Graduate Medical Education proposed updated guidelines that are to be refined before adoption next year.
University of Colorado lists five teaching hospitals in Colorado: University of Colorado Hospital, Denver Health Medical Center, Veterans Administration Medical Center, The Children’s’ Hospital and Rose Medical Center.