Objective: Many studies have examined the July effect. However, little is known regarding the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes in patients with sepsis.
Methods: Prospectively collected patients with sepsis between January 2018 and December 2021 were used. In Korea, the new academic year starts on March 1, so the "July effect" appears in March. The primary outcome was 30-day mortality. Secondary outcomes included adherence to the Surviving Sepsis Campaign bundle. Outcomes were compared between March and other months. Multivariate Cox proportional hazard regression was performed to adjust confounders.
Results: Total 843 patients were included. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49% vs. 28.5%; P < 0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%; P = 0.264). Multivariate Cox proportional hazard regression showed that July effect was associated with mortality in patients with sepsis [adjusted hazard ratio, 1.925; 95% confidence interval, 1.405-2.638; P < 0.001].
Conclusion: July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence was not different. These results suggest that the increase in mortality during the turnover period may be related to unmeasured in-hospital management. Intensive supervision and education of residents in care of patients with sepsis is needed in the beginning of training.
Keywords: Medical education; Patient safety; Precision medicine; Sepsis.