Dr Foster shows fresh thinking needed on the week junior doctors start

A new study by Dr Foster has revealed that patients admitted to English hospitals in an emergency on the first Wednesday in August have a six per cent higher mortality rate than people admitted on the previous Wednesday.

Newly qualified junior doctors start their new positions in NHS hospitals in England on the first Wednesday in August.

The Dr Foster Unit at Imperial College London who conducted the research says the excess mortality rates may be linked to this influx of newly qualified doctors but more research is needed before any firm conclusions can be made.

Mortality rates change throughout the year, with higher rates in the winter. However, the Dr Foster study suggests that even though the increase in mortality is small, it is statistically significant and the pattern was consistent over the nine years of the study.

Study background

The study followed almost 300,000 patients admitted to hospitals in an emergency across 175 NHS trusts between 2000 and 2008. Over the nine years, one group of 151,844 people were admitted on the last Wednesday in July and the other group of 147,897 were admitted on the first Wednesday in August.

The researchers followed both sets of patients for a week and looked at the death rate in each group while they were in hospital. There were 2,182 deaths in patients admitted on the last Wednesday in July, while 2,227 patients died who had been admitted on the first Wednesday in August.

Study findings

The study did not analyse the causes of individual deaths and researchers say further studies are needed before they can draw any firm conclusions about why the apparent increase in mortality rates might be happening.

Even though the difference in the mortality rate between the two groups was not significant, when researchers looked at age, sex, socio-economic deprivation, year and additional diagnoses, they discovered a six per cent increase in mortality rates for the first Wednesday in August compared with the previous last Wednesday of July.

Comment

Study leader Dr Paul Aylin said: "We wanted to find out whether mortality rates changed on the first Wednesday in August, which is 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."

"Our study doesn’t 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," explained Dr Aylin.

Tim Kelsey, Chair of Dr Foster added: "Dr Foster encourages the analysis of data and its publication as an important step to the ongoing improvement of standards within the NHS. Although more research needs to be done the study would appear to show some fresh thinking needs to be applied in the week junior doctors begin their careers."

In response, Patricia Hamilton, the NHS's director of medical education, was reported as saying there was no evidence of a link between when junior doctors start and mortality rates.

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