Junior doctor changeover likely to drive August reduction in quality and safety of patient care

New research suggests that failure by junior doctors in their annual changeover period to identify deteriorating patients and poor prioritisation skills are likely to drive a reduction in the quality and safety of patient care.

Next Wednesday 7 August thousands of newly qualified doctors will take up their first hospital jobs and junior doctors will become a grade more senior. This period is associated with worse clinical outcomes than the rest of the year. Researchers writing in JRSM Short Reports, the open-access offshoot to the Journal of the Royal Society of Medicine, found that there was a significant increase in the number of urgent medical tasks after changeover, but that new junior doctors completed routine tasks quicker than their more experienced predecessors. The researchers analysed data from the wireless system for the management of out-of-hours workflow at City Hospital and the Queen’s Medical Centre, Nottingham.

Leading the research team, Dr John Blakey of the Liverpool School of Tropical Medicine, said: “The abrupt change to the provision of care by junior doctors who are inexperienced, or who are less experienced for their level of seniority, presents clear potential for a reduction in the quality and safety of patient care.” Referred to as the ‘August effect’, the situation causes great concern amongst the medical community, especially in the light of reports suggesting medical students are poorly prepared for their first post.

The researchers found there was no change in the overall volume of work requested of junior doctors but that there was a significant increase in the volume of requests for more urgent and serious problems. “This amounts to a considerable cumulative duration of unresolved patient risk per month”, said Dr Blakey. He added: “New junior doctors also completed routine tasks more quickly than their predecessors. This is because they appear to work through tasks based more on their proximity rather than how urgent they are.”

Junior doctor changeover likely to drive August reduction in quality and safety of patient careThe new study lends empirical evidence to qualitative research investigating whether junior doctors are prepared for the practicalities and complexities of their first posting, say the researchers. They suggest improved training, supervision and quality control could reduce omissions, errors, failure to recognise deterioration and poor task prioritisation skills.

What drives the ‘August effect’? An observational study of the effect of junior doctor changeover on out of hours work (DOI: 10.1177/2042533313489823) will be published online by JRSM Short Reports at 00:05 hrs (UK time) on Wednesday 31 July 2013. Please make sure you mention or link to the journal in your piece.

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