The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year?
Introduction: There has been concern of increased emergency department (ED) length of stay (LOS) during the months when new residents are orienting to their roles. This so-called “July Effect” has long been thought to increase LOS, and potentially contribute to hospital overcrowding and increased wa...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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eScholarship Publishing, University of California
2014-02-01
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| Series: | Western Journal of Emergency Medicine |
| Subjects: | |
| Online Access: | http://escholarship.org/uc/item/40k809h6# |
| _version_ | 1818981115150467072 |
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| author | Christine Riguzzi H. Gene Hern Farnaz Vahidnia |
| author_facet | Christine Riguzzi H. Gene Hern Farnaz Vahidnia |
| author_sort | Christine Riguzzi |
| collection | DOAJ |
| description | Introduction: There has been concern of increased emergency department (ED) length of stay (LOS) during the months when new residents are orienting to their roles. This so-called “July Effect” has long been thought to increase LOS, and potentially contribute to hospital overcrowding and increased waiting time for patients. The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents.Methods: We performed a retrospective analysis of a nationally representative sample of 283,621 ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2001 to 2008. We stratified the sample by proportion of visits seen by a resident, and compared July to the rest of the year, July to June, and July and August to the remainder of the year. We compared LOS for teaching hospitals to non-teaching hospitals. We used bivariate statistics, and multivariable regression modeling to adjust for covariates.Results: Our findings show that at teaching hospitals with residents, there is no significant difference in mean LOS for the month of July (275 minutes) versus the rest of the year (259 min), July and August versus the rest of the year, or July versus June. Non-teaching hospital control samples yielded similar results with no significant difference in LOS for the same time periods. There was a significant difference found in mean LOS at teaching hospitals (260 minutes) as compared to non-teaching hospitals (185 minutes) throughout the year (p<0.0001).Conclusion: Teaching hospitals with residents in the ED have slower throughput of patients, no matter what time of year. Thus, the “July Effect” does not appear to a factor in ED LOS. This has implications as overcrowding and patient boarding become more of a concern in our increasingly busy EDs. These results question the need for additional staffing early in the academic year. Teaching hospitals may already institute more robust staffing during this time, preventing any significant increase in LOS. Multiple factors contribute to long stays in the ED. While patients seen by residents stay longer in the ED, there is little variability throughout the academic year. [West J Emerg Med. 2014;15(1):88–93.] |
| first_indexed | 2024-12-20T17:26:11Z |
| format | Article |
| id | doaj.art-d4f3d10e912b4180909eccb07eb205fa |
| institution | Directory Open Access Journal |
| issn | 1936-900X 1936-9018 |
| language | English |
| last_indexed | 2024-12-20T17:26:11Z |
| publishDate | 2014-02-01 |
| publisher | eScholarship Publishing, University of California |
| record_format | Article |
| series | Western Journal of Emergency Medicine |
| spelling | doaj.art-d4f3d10e912b4180909eccb07eb205fa2022-12-21T19:31:35ZengeScholarship Publishing, University of CaliforniaWestern Journal of Emergency Medicine1936-900X1936-90182014-02-01151889310.5811/westjem.2013.10.18123The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year?Christine Riguzzi0H. Gene Hern1Farnaz Vahidnia2Highland Hospital, Alameda Health System, Oakland, CaliforniaHighland Hospital, Alameda Health System, Oakland, CaliforniaHighland Hospital, Alameda Health System, Oakland, CaliforniaIntroduction: There has been concern of increased emergency department (ED) length of stay (LOS) during the months when new residents are orienting to their roles. This so-called “July Effect” has long been thought to increase LOS, and potentially contribute to hospital overcrowding and increased waiting time for patients. The objective of this study is to determine if the average ED LOS at the beginning of the hospital academic year differs for teaching hospitals with residents in the ED, when compared to other months of the year, and as compared to non-teaching hospitals without residents.Methods: We performed a retrospective analysis of a nationally representative sample of 283,621 ED visits from the National Hospital Ambulatory Medical Care Survey (NHAMCS), from 2001 to 2008. We stratified the sample by proportion of visits seen by a resident, and compared July to the rest of the year, July to June, and July and August to the remainder of the year. We compared LOS for teaching hospitals to non-teaching hospitals. We used bivariate statistics, and multivariable regression modeling to adjust for covariates.Results: Our findings show that at teaching hospitals with residents, there is no significant difference in mean LOS for the month of July (275 minutes) versus the rest of the year (259 min), July and August versus the rest of the year, or July versus June. Non-teaching hospital control samples yielded similar results with no significant difference in LOS for the same time periods. There was a significant difference found in mean LOS at teaching hospitals (260 minutes) as compared to non-teaching hospitals (185 minutes) throughout the year (p<0.0001).Conclusion: Teaching hospitals with residents in the ED have slower throughput of patients, no matter what time of year. Thus, the “July Effect” does not appear to a factor in ED LOS. This has implications as overcrowding and patient boarding become more of a concern in our increasingly busy EDs. These results question the need for additional staffing early in the academic year. Teaching hospitals may already institute more robust staffing during this time, preventing any significant increase in LOS. Multiple factors contribute to long stays in the ED. While patients seen by residents stay longer in the ED, there is little variability throughout the academic year. [West J Emerg Med. 2014;15(1):88–93.]http://escholarship.org/uc/item/40k809h6#resident educationemergency department length of stayemergency medicine |
| spellingShingle | Christine Riguzzi H. Gene Hern Farnaz Vahidnia The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year? Western Journal of Emergency Medicine resident education emergency department length of stay emergency medicine |
| title | The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year? |
| title_full | The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year? |
| title_fullStr | The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year? |
| title_full_unstemmed | The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year? |
| title_short | The July Effect: Is Emergency Department Length of Stay Greater at the Beginning of the Hospital Academic Year? |
| title_sort | july effect is emergency department length of stay greater at the beginning of the hospital academic year |
| topic | resident education emergency department length of stay emergency medicine |
| url | http://escholarship.org/uc/item/40k809h6# |
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