Reduce the effect of July for heart surgery

The idea that more medical errors occur in July compared to other months due to the influx of new medical graduates who are starting their training at the hospital are not sure. not apply to cardiac surgery, according to a study by The annals of thoracic surgery, published by Elsevier.

While the perception of the "July effect" persists culturally among health care providers, we hope this study reinforces the fact that hospital systems have processes in place to provide the highest level of care. care and guarantee the safety of patients. Our results are encouraging. "

Sameer A. Hirji, MD, Brigham and Women's Hospital in Boston, MA, United States

Researchers from Brigham and Women's Hospital and Harvard University reviewed the data from the National Inpatient Sample, which is part of a family of databases developed by the Agency for Health Research and Quality and provides information on more than 35 million hospitalizations.

The group badyzed more than 470,000 standard cardiac procedures such as coronary artery bypbad graft (CABG); replacement of the aortic valve; repair or replacement of the mitral valve; Thoracic aortic aneurysm (TAA) replaced between 2012 and 2014 on adult patients. For each procedure, overall trends were compared by quartile of academic year: Q1 (July to September with the least experienced residents) and Q4 (April to June with the most experienced residents). The researchers found no difference in mortality, hospital complications, costs or length of stay between the first-trimester and fourth-trimester patients.

"Patients in cardiac surgery are managed in a multidisciplinary manner, therefore the well-being of patients does not depend solely on an individual, but on the entire health care team and could therefore be more resistant to changes in hospital staff, "said Rohan M Shah, MD, MPH. "What this means for patients is that they do not have to fear or be operated on in July as new residents begin."

In addition, the study showed that, even though teaching status in hospitals did not influence the risk-adjusted mortality rates of PAC and TAA surgeries, hospitals of teaching performed better than non-university hospitals with lower mortality in the first quarter than the fourth quarter for aortic and mitral procedures. Dr. Shah explained that it was an important discovery with implications for the training and education of residents in the operating room.

The future of surgeon training

Most cardiac surgery teams recognize that July is a "vulnerable" period when one expects "direct and strict" supervision from residents, according to Dr. Hirji. However, over the years, the autonomy of residents is increasing.

"The balance between supervision and resident autonomy is constantly changing during teaching," Dr. Hirji said. "It's a good balance and, as this study indicates, our specialty is doing a great job."

Even in this case, Dr. Shah stated that the effectiveness of traditional training programs in relation to new training paradigms, such as the increasingly popular Accelerated Path (Model 4 + 3) and the Pathway, needed to be evaluated. integrated (program I-6). .

As part of the traditional pathway, residents are trained in general surgery for five years, consisting of a rotation of clinical techniques in the various surgical disciplines, followed by two to three years of residency in cardiothoracic surgery. . The result is a surgeon generally trained in cardiothoracic surgery.

The 4 plus 3 model includes four years of training in general surgery, followed by three years of cardiothoracic residency. The resident is introduced to cardiothoracic surgery earlier in the training path, giving them more time to master their skills.

Program I-6 is the most recent training model and offers even earlier exposure to cardiothoracic surgery. Residents apply directly to an integrated residency program in cardiothoracic surgery for 6 years in total total immersion in the diagnosis and management of cardiovascular and thoracic diseases, through multidisciplinary training and exposure to related fields such as cardiology, radiology, oncology and endovascular surgery.

"This study highlights the central role of appropriate education for residents that does not compromise the results for patients," said author correspondent, Tsuyoshi Kaneko, MD. "Patient safety will always be the first priority."