Why you should avoid hospitals in January

More Australian patients have a complication in hospitals during January than other months.

man in hospital gown using walker

Around 3,000 more Australian patients have a complication in their hospital care in January than in other months. Rawpixel.com

by Stephen Duckett, Grattan Institute and Greg Moran, Grattan Institute

January is the quietest month in Australia. But for hospitals, which provide care 24/7/365, January is a time of big transition. And for patients, that means January is when things are more likely to go wrong.

More than 3,000 newly graduated doctors will enter the next phase of their training in January. New nurses and allied health professionals, such as physiotherapists and hospital pharmacists, also join the workforce in January.

These new staff fill the posts vacated by people one year ahead of them in the pipeline. Last year’s first-year-out doctor goes into his second year of training, and his predecessor goes into her third-year role or leaves the hospital to join a new workplace.

These new minds and hands, and the massive reshuffles of existing staff, disrupt hospitals. Old informal networks break down as new relationships are forged, and the less-experienced staff learn the hospital’s processes and expectations.


Read more: Reducing medical errors, one patient at a time


Not surprisingly, this staff disruption has an impact on patient care. Around the world, overblown descriptions of the changeover period as the “killing season” and of doctors’ first day in the UK as “Black Wednesday” have become part of medical folklore.

More sober studies of the “July Effect” (so named in the northern hemisphere) have indeed found evidence of worse patient outcomes during the changeover period.

The graph below shows the trend in complications in Australian hospitals over the past few years. It reveals a small but clear “January Effect”. On average, at least one complication occurs in just under 11% of hospital admissions in Australia. But each January, this rate ticks up by more than half a percentage point.

What goes wrong?

New staff might be less adept at monitoring patients, leading to the patient becoming malnourished. Or the new staff may not have acquired sufficient technical skills leading to an accidental puncture or laceration during a procedure.

Other hospital complications include pressure sores from not moving enough, infections from hygiene breaches, and being given the wrong dose or type of drug.

In January 2015, about 74,000 hospital patients in Australia had a complication of care, about 3,000 more than would have been expected if there were no January Effect. That is 3,000 people suffering complications that might not have arisen had they received care at “normal” times of the year.

What hospitals can do

Although the effect is clear, the causes – and therefore, solutions – are not. Is it the effect of the new doctors and other staff who are inadequately prepared for their new responsibilities? Or is it team disruption? Or is it that senior staff take their leave over January, resulting in weaker supervision just when it is needed most? Probably all of the above.

To the extent the problem is diminished supervision, start dates for new staff could be pushed back a month or so. Perhaps senior staff leave could be more evenly spread across the year.


Read more – Infections, complications and safety breaches: why patients need better data on how hospitals compare


If the problem is poorly prepared junior staff, then a longer and better induction might be the answer. Typically newly graduated doctors now have a one-week introduction, this could be extended or restructured to include more time to be introduced to the specific practices of units they will be joining.

If the problem is disrupted teamwork, the solution might involve better handover and induction processes, either as part of the formal induction period, or as a structured experience when they join their new unit.

Most likely, all facets will need to be improved.

What patients and their advocates can do

The January Effect underlines the fallibility of the people and systems that deliver our hospital care. Australia’s hospital system is staffed by motivated and highly trained people working in well-developed systems, often using state-of-the-art technologies and medicines.

But people can make mistakes, particularly when they are new to a task. Systems can break down. Patients in Australia can take comfort in the safety and quality of hospital care, but they should not assume it is perfect.


Read more: Blaming individual doctors for medical errors doesn’t help anyone


The burden of fixing health system problems should never rest on the shoulders of those with least power – patients and their families and carers. But patients do have a role. Alert and active patients and their families and carers can help identify and prevent errors – and this role becomes slightly more important in January.

Patients often know when they are about to be given the wrong medication, or when their regular medication has been stopped, or when the care they are about to get has not been fully discussed with them so might be wrong. They can speak up and prevent the problem – but too often they feel put down, disempowered and dismissed.

The ConversationSo the simple message for patients is this: if you see something that doesn’t look right, speak up, and speak up again.

Stephen Duckett, Director, Health Program, Grattan Institute and Greg Moran, Associate, Grattan Institute

This article was originally published on The Conversation. Read the original article.





    COMMENTS

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    16th Jan 2018
    11:15am
    The health sector is terribly underfunded, given the needs.
    john
    16th Jan 2018
    12:00pm
    MY DAUGHTER WENT TO HOSPITAL WHEN SHE NEEDED TO. I DIDN'T READ THIS ARTICLE FULLY.

    But I find the subject irresponsible , with the headline as well. You go to hospital if you have to whether its January or what ever month. Frightening people with these types of articles is just silly.
    For Your Life Choices which caters to older people. I would have thought, you may have thought as well, before putting things like this up.
    Thankfully my pregnant daughter was fine and the the Hospital too.
    arbee
    16th Jan 2018
    12:20pm
    Agree with you 100%. In fact the opposite may also apply in that the new doctors and nurses may well be a lot more thorough in their care than those who have been there a long time and have got complacent with their treatment.
    Know what your medication is and always check that you are being given the correct dosage.
    Rosret
    16th Jan 2018
    6:24pm
    Actually John I am concerned when any of my family go to casualty no matter when. The medical staff are under trained, the hospital is not satisfactorily clean and the qualified staff are exhausted and the specialists are on holidays.
    NEVER go alone. You need someone to watch over and monitor the staff at all times. I tell my family not to touch anything and be super careful using the toilets.
    Its not a matter of being frightened - its about being aware and think sterile sterile sterile.
    KB
    16th Jan 2018
    12:31pm
    Spot on this article. I had ne new nurse on that had just graduated. She was new to the situation with showering and I just gave her some friendly advice. Never to leave a patient alone that that just a hip operation. The floor was slippery and I could have fallen. The lass was grateful for the advice as I did not want her to get into trouble. Patients do need to speak up for themselves or their families and carers particularly when it come to medication. Unfortunately a person cannot always choose when he or she needs hospital; treatment.


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