LAUSR

Introduction/Hypothesis: ‘July effect’ is the perceived increase in the rate of medical errors and complications due to the influx of relatively new and inexperienced medical trainees in July. Many studies assessing the “July effect” in United States hospitals have yielded mixed results. We examined if the effect exists in the outcomes of patients with Acute Respiratory Distress Syndrome (ARDS) Methods: The National Inpatient Sample database was queried for all adult (≥ 18 years) ARDS patients that received mechanical ventilation from 2012 – 2014. Using a multivariate differenceindifference model, we compared the differences in mortality, ventilator-associated pneumonia [VAP], post-procedural air leak and pneumothorax [PPP], central line-associated bloodstream infections [CLABSI], and Clostridium difficile infection [CDI]) between teaching and non-teaching hospitals in the months of April-May and July-August. We also examined health resource utilization associated with ARDS in both teaching and non-teaching hospitals during July – August, and April – May Results: 407,080 hospitalizations occurred in April – May and 389,710 in July – August. Using multivariate analyses, there was no statistically significant difference seen in the adjusted odds of outcomes between July – August and April – May in teaching hospitals vs non-teaching hospitals for all-cause inpatient mortality (OR: 1.03, 95% CI: 0.98 – 1.08), VAP (OR: 1.11, 95% CI: 0.89 – 1.37), post-procedural air leak/pneumothorax (OR: 0.95, 95% CI: 0.77 – 1.18), CLABSI (OR: 1.16, 95% CI: 0.88 – 1.53), CDI (OR: 1.03, 95% CI: 0.92 – 1.14) and any complications (OR: 1.04, 95% CI: 0.96 – 1.14). There was no difference in the LOS between the moths of April – May, and July – August for both teaching hospitals (14.0 vs 14.3) and nonteaching hospitals (10.9 vs. 10.8). However, total hospital costs were slightly higher in July August vs. April – May for both teaching hospitals ($50,123 vs. $48, 051; P< 0.001) and non-teaching hospitals ($35, 629 vs. $34,932); P =0.01) Conclusions: ‘July effect’ was not observed in mortality and complication rates in mechanically ventilated ARDS patients. Though no ‘July effect’ was noted in patients LOS, total healthcare costs were relatively higher in July August compared to April May in both teaching and non-teaching hospitals.