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Inductions for new doctors could prevent the ‘August effect’, when patient mortality rises

Review shows inductions lead to fewer errors in clinical procedures

A review from Birkbeck says that new doctor inductions could reduce the ‘August effect’, which sees patient mortality in hospitals rise by 12% during August, when new doctors take up their posts.

The review by Dr Caroline Kamau of Birkbeck's Department of Organizational Psychology has highlighted the important role of inductions for newly qualified doctors in an article published this month in Clinical Medicine, the journal of the Royal College of Physicians.

Dr Kamau calls for the introduction of clinical skills inductions (orientations) before doctors’ first day at work. The average efficiency in hospitals declines considerably, by up to 7.2%, after newly qualified doctors start work. Clinical procedures take longer and time is taken by other staff to provide guidance. The spill-over effects are lower patient safety and a greater risk of patient death. Dr Kamau’s research shows that, whereas 96% of uninducted new doctors fail one or more clinical procedure tests, the failure rate was reduced substantially after the doctors were inducted. Improvements spanned a range of vital clinical skills including intravenous line insertion and drug administration, certifying death, prescribing and catheterisation.

Dr Kamau said, "There is value in scheduling inductions before doctors report for their first day on the job. Doing this can help solve the hospital efficiency problem that is responsible for the ‘August effect’. Inductions look like a worthwhile intervention in clinical contexts that, unlike surgery and Intensive Care Units, currently have no stringent buffers against reduced efficiency in August. Induction provision for newly qualified doctors joining the NHS should be seriously considered.

“The NHS and health organizations in other countries should reconsider the timing and content of clinical skills inductions. Inductions before day one on the job could save lives.”

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