The mortality of patients with sepsis increases in the first month of a new academic year

Sukyo Lee; Sungjin Kim; Sejoong Ahn; Hanjin Cho; Sungwoo Moon; Young Duck Cho; Jong-Hak Park

doi:10.15441/ceem.23.117

Clin Exp Emerg Med > Accepted Articles

Original Article

doi: https://doi.org/10.15441/ceem.23.117 [Accepted]

The mortality of patients with sepsis increases in the first month of a new academic year

¹Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Korea
²Department of Emergency Medicine, Korea University Guro Hospital, Seoul, Korea

Correspondence Jong-Hak Park Email: roadrunner@korea.ac.kr

Received: August 28, 2023. Revised: October 31, 2023. Accepted: October 31, 2023. Published online: January 29, 2024.

ABSTRACT

Objective
Many studies have examined the July effect. However, little is known about the July effect in sepsis. We hypothesized that the July effect would result in worse outcomes for patients with sepsis.
Methods
Patients with sepsis prospectively collected between January 2018 and December 2021 were analyzed. 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. A multivariate Cox proportional hazard regression was performed to adjust for confounders.
Results
We included 843 patients. There were no significant differences in sepsis severity. The 30-day mortality in March was higher (49.0% vs. 28.5%, P<0.001). However, there was no difference in bundle adherence in March (42.2% vs. 48.0%, P=0.264). The multivariate Cox proportional hazard regression showed that the July effect was associated with 30-day mortality in patients with sepsis (adjusted hazard ratio, 1.925; 95% confidence interval, 1.405–2.638; P<0.001).
Conclusion
The July effect was associated with 30-day mortality in patients with sepsis. However, bundle adherence did not differ. These results suggest that the increase in mortality during the turnover period might be related to unmeasured in-hospital management. Intensive supervision and education of residents caring for patients with sepsis is needed in the beginning of training.

Keywords: Sepsis; Medical education; Patient safety; Precision medicine