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doi:10.5847/wjem.j.1920-8642.2022.039

World Journal of Emergency Medicine ›› 2022, Vol. 13 ›› Issue (3): 215-218.doi: 10.5847/wjem.j.1920-8642.2022.039

• Research Letters • Previous Articles Next Articles

The "July Effect" in the intensive care units revisited: A bi-institutional 6-year experience of 57,160 patients

Leon Naar¹, Ander D. Gallastegi¹, Raghu R. Seethala², B. Christian Renne¹^,³, Michael E. Billington², Jasmine Kannikal², Haytham M.A. Kaafarani¹, Jarone Lee¹^,³()

¹Division of Trauma, Emergency Surgery & Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston 02114-2696, USA
²Division of Emergency Critical Care Medicine, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston 02115-6195, USA
³Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 02115-6195, USA

Received:2021-06-16 Accepted:2021-12-20 Online:2022-05-13 Published:2022-05-01
Contact: Jarone Lee E-mail:Jarone.Lee@mgh.harvard.edu

Abstract

Leon Naar, Ander D. Gallastegi, Raghu R. Seethala, B. Christian Renne, Michael E. Billington, Jasmine Kannikal, Haytham M.A. Kaafarani, Jarone Lee. The "July Effect" in the intensive care units revisited: A bi-institutional 6-year experience of 57,160 patients[J]. World Journal of Emergency Medicine, 2022, 13(3): 215-218.

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References 5

1	Finkielman JD, Morales lJ, Peters SG, Keegan MT, Ensminger SA, Lymp JF, et al. Mortality rate and length of stay of patients admitted to the intensive care unit in July. Crit Care Med. 2004; 32(5):1161-5. pmid: 15190967
2	Philibert I, Chang B, Flynn T, Friedmann P, Minter R, Scher E, et al. The 2003 common duty hour limits: process, outcome, and lessons learned. J Graduate Med Educ. 2009; 1(2):334-7. doi: 10.4300/JGME-D-09-00076.1
3	Philibert I, Amis S, Emily Vasiliou E, Force Coordinator T. The ACGME 2011 duty hour standards: enhancing quality of care, supervision, and resident professional development ACGME task force on quality care and professionalism. Accreditation Council for Graduate Medical Education (ACGME). Chicago; 2011.
4	Li B, Evans D, Faris P, Dean S, Quan HD. Risk adjustment performance of Charlson and Elixhauser comorbidities in ICD-9 and ICD-10 administrative databases. BMC Health Serv Res. 2008; 8:12. doi: 10.1186/1472-6963-8-12
5	Barry WA, Rosenthal GE. Is there a July phenomenon? The effect of July admission on intensive care mortality and length of stay in teaching hospitals. J Gen Intern Med. 2003; 18(8):639-45. doi: 10.1046/j.1525-1497.2003.20605.x

Parameters	July (n=4,992)	Non-July (n=52,168)	P-value
Age, years, median (IQR)	65 (54-76)	66 (54-76)	0.02
Female, n (%)	2,076 (41.6)	22,377 (42.9)	0.08
Race, n (%)			0.50
White	4,010 (80.3)	42,274 (81.0)
Black	302 (6.1)	3,169 (6.1)
Hispanic	224 (4.5)	2,120 (4.1)
Asian	124 (2.5)	1,170 (2.2)
Other	44 (0.9)	396 (0.8)
Unknown	288 (5.8)	3,039 (5.8)
Elixhauser comorbidity index, median (IQR)	16 (9-24)	16 (9-24)	0.46
ICU type, n (%)			0.67
Burn/Trauma ICU	287 (5.7)	3,258 (6.2)
CCU	637 (12.8)	6,646 (12.7)
CTICU	1,154 (23.1)	11,854 (22.7)
MICU	914 (18.3)	9,796 (18.8)
NSICU	1,108 (22.2)	11,526 (22.1)
SICU	892 (17.9)	9,088 (17.4)

Parameters	July (n=4,992)	Non-July (n=52,168)	P-value
ICU length of stay, d, median (IQR)	2.7 (1.2-5.6)	2.5 (1.2-5.2)	0.62
The 30-day mortality, n (%)	538 (10.8)	6,034 (11.6)	0.10
The 365-day mortality, n (%)	1,203 (24.1)	13,283 (25.5)	0.04

Parameters	Odds ratio	95% confidence interval	P-value
The 30-day mortality rate (July vs. other months) 0.92 0.84-1.02 0.11
The 365-day mortality rate (July vs. other months)	0.92	0.85-0.99	0.02

Parameters	Odds ratio	95% confidence interval	P-value
The 30-day mortality rate (July vs. other months) 0.95 0.78-1.16 0.63
The 365-day mortality rate (July vs. other months)	0.92	0.79-1.08	0.31

Parameters	Odds ratio	95% confidence interval	P-value
The 30-day mortality rate (July vs. other months) 0.85 0.72-1.02 0.08
The 365-day mortality rate (July vs. other months)	0.96	0.83-1.11	0.60

The "July Effect" in the intensive care units revisited: A bi-institutional 6-year experience of 57,160 patients

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Parameters	Odds ratio	95% confidence interval	P-value
The 30-day mortality rate (July vs. other months) 0.95 0.83-1.09 0.47
The 365-day mortality rate (July vs. other months)	0.90	0.82-0.99	0.03

Parameters	Odds ratio	95% confidence interval	P-value
The 30-day mortality rate (July-August vs. September-June) 0.97 0.90-1.04 0.37
The 365-day mortality rate (July-August vs. September-June)	0.95	0.90-1.00	0.09

Parameters	Odds ratio	95% confidence interval	P-value
The 30-day mortality rate (July-September vs. October-June) 1.04 0.98-1.10 0.18
The 365-day mortality rate (July-September vs. October-June)	0.98	0.94-1.03	0.49