The july effect: an analysis of never events in the nationwide inpatient sample

Abstract

Background: Prior studies examining the impact of the "July effect" on in-hospital mortality rates have generated variable results. In 2008, the Centers for Medicare & Medicaid Services published a series of high-cost, high-volume, nonreimbursable hospital-acquired complications (HACs). These events were believed to be preventable and indicate deficiencies in healthcare delivery.

Objective: The present study aims to investigate the impact of July admissions on patient safety in a national sample using the HACs as a metric.

Design/setting/patients: Discharge data were collected from all admissions recorded in the Nationwide Inpatient Sample database from 2008 to 2011. HAC incidence was evaluated as a function of admission month, adjusting for demographic and hospital factors in multivariable analysis.

Measures: The outcome measures were HAC occurrence, prolonged length of stay (LOS), and higher inpatient costs.

Results: A total of 143,019,381 inpatient admissions were recorded, with an overall HAC occurrence of 4.7%. July admissions accounted for 7.6% of the total number of inpatient admissions. July admissions experienced a 6% increase in likelihood of HAC occurrence (odds ratio = 1.06, 95% confidence interval: 1.06-1.07, P < 0.001) when compared to those admitted during all other months. Patients with HAC occurrence had almost 2 times increased likelihood of prolonged LOS (P < 0.001) and higher inpatient costs (P < 0.001).

Conclusions: July admissions are associated with increased likelihood of HAC occurrence. This trend may represent breakdowns in organization structure distinct from traditional quality measures, requiring novel transition protocols dedicated to improving HACs.