Health & Wellness

A UK study suggests that the mortality rate (MR) of Emergency Room patients is elevated in NHS hospitals when admitted during the influx of newly qualified doctors.
This research study from Imperial College, London has noticed that there is a small but significant rise in ER patient mortality during the week starting from the 1st Wednesday in August, a day that traditionally marks the arrival of the new intake of doctors in NHS hospitals in England. This effectively validates the fairly widely held assumption that there is indeed a causal relationship between the intakes of about 50,000 recently qualified doctors on this day and the increased death rate.

The MR increase is about 6% higher than for those patients who were admitted a week earlier. This was for a mix of patients which included, medical, surgical and neoplasm admissions. Indeed this figure increased to an 8% rise in the MR for purely medical patients. The study was based upon an examination of 300,000 emergency admissions between 2000 and 2008,

Factors such as age, sex, economic & social background, as well as any further diagnoses were taken into consideration before acknowledging this “statistically significant” trend. However the study was not able to firm-up on any conclusions about any underlying factors upon which this increase in ER patient mortality is predicated.

A spokesman for the Dr Foster Unit at Imperial College London, Dr Paul Aylin is quoted as follows:
“We wanted to find out whether mortality rates changed on the first Wednesday in August, when junior doctors take up their new posts. What we have found looks like an interesting pattern and we would now like to look at this in more detail to find out what might be causing the increase.

He continued: “Our study does not mean that people should avoid going into hospital that week. This is a relatively small difference in mortality rates, and the numbers of excess deaths are very low. It’s too early to say what might be causing it. It might simply be the result of differences between the patients who were admitted.”

The conclusions of the report, which was published in the journal PLos One were:
“We found evidence that patients admitted on the first Wednesday in August have a higher early death rate in English hospitals compared with patients admitted on the previous Wednesday. This was higher for patients admitted with a medical primary diagnosis.”

The chairman of the British Medical Association’s Junior Doctor Committee, Dr Shree Datta, has stated:
“This study has to be judged alongside many previous studies looking at mortality rates before and after junior doctors start their new jobs, which have not shown any differences. Clearly even a small increase in death rates is of great concern and we need further research to see whether this is a real effect or an anomaly.”

Patient groups however, are still convinced that most junior doctors are just left to their own devices and are simply “thrown in at the deep end”, perhaps with insufficient training, supervision or pre-briefing even via memos or handover notes etc. The NHS of course demurs that conditions have improved considerably in the past few years.

Perhaps it’s best to play safe and acknowledge that early August is an “unsafe period” to be admitted to your friendly neighbourhood hospital’s Casualty Department when the Greenhorn Medicos are about!

Having said that, in early August last year, I was taken into Casualty with severe chest pains and a suspected Heart Attack. The new doctors were magnificent and did everything possible to keep me comfortable. Indeed one of them actually called me the next day to advise me that she had been thinking about my case in her free time and had prescribed me some additional medication. Awesome!

For more details please visit the following link:

Trainee Doctors and Early In-Hospital Mortality

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