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Research confirms rise in number of new physicians

Research shows that an influx of fledgling physicians to hospitals nationwide each July contributes to a rise in patient deaths and inefficiencies in care. But the extent of those increases and the reasons behind them remain unclear, says an Annals of Internal Medicine study. Many researchers have studied the so-called July effect, in which patient outcomes decline as a result of hospitals undergoing major work-force changes as new residents come in and older ones complete their training. "Teaching hospitals experience a massive exodus of highly experienced physician trainees who are also familiar with the working environment of the hospital," said John Q. Young, MD, lead study author and associate program director of the University of California, San Francisco, School of Medicine's psychiatry residency program. "Those that remain assume new, more responsible roles in treating patients. And many newly minted physicians arrive to begin their training." He likened it to a footba ...

Texas refuses to launch health insurance exchange

Texas declined to create a health insurance exchange during the legislative session that ended June 30, but the state did advance its own version of accountable care organizations. Gov. Rick Perry strongly opposes the health system reform law and threatened to veto any legislation that would help implement the law's health insurance exchanges. The exchanges will serve as one-stop marketplaces for qualifying health coverage beginning in 2014. Perry did not want to be seen as aiding the implementation of the health reform law in any way, said Texas Rep. John Zerwas, MD, sponsor of the leading bill to create an exchange, and Texas Medical Assn. President Bruce Malone, MD, in separate interviews. "They definitely were just very entrenched on this idea," Dr. Zerwas said. At least one other governor, Bobby Jindal of Louisiana, opposes creating a locally controlled exchange in his state. The Texas Medical Assn. supported Dr. Zerwas' measure to authorize a state insurance exchange. Ho ...

Checklists more effective when physicians are prompted to use them

Checklists have been used successfully to improve surgical safety and cut infection rates in the intensive care unit, but a study suggests that checklists are even more effective when physicians are prompted by a colleague to take action on information gathered using the quality improvement tool. A study of 265 critical care patients at Northwestern Memorial Hospital in Chicago found that intensivists who relied on checklists alone did not reduce mortality rates. However, the death rate was cut in half when the checklist was accompanied by residents who asked the attending physicians how to act on information related to matters such as antibiotic prescribing, ventilator use and central-line placement. The residents were asked to nudge physicians if the checklist indicated a need for a question, and the residents were given a script of what to ask. "We always saw the checklist as sort of a data repository meant to trigger a decision," said Curtis H. Weiss, MD, lead author of th ...