A “Reverse July Effect”: Association Between Timing of Admission, Medical Team Workload, and 30-Day Readmission Rate

Abstract

Abstract Background High teaching team workload has been associated with poor supervision and worse patient outcomes, yet it is unclear whether this association is more pronounced during the early months of the academic year when the residents are less experienced. Objective We examined the associations between teaching team workload, timing of admission, and the 30-day readmission rate. Methods In this retrospective observational study, all admissions to an urban internal medicine teaching service over a 16-month period were divided into 2 groups based on admission date: early in the academic year (July–September) or late (October–June) and further defined as being admitted to “busy” versus “less busy” teams based on number of monthly admissions. The primary outcome was 30-day readmission rate. Multivariate logistic regression was used to determine the independent association between teaching team workload and readmission rates, stratified by time of year of admission after adjustment for demographic and clinical characteristics. Results Of 12 118 admissions examined, 2352 (19.4%) were admitted early in the year, and 9766 (80.6%) were admitted later. After multivariate adjustment, we found that patients admitted to busy versus less busy teams in the first quarter had similar 30-day readmission rate (odds ratio [OR]adj  =  1.03 [0.82–1.30]). Later year admission to a busy team was associated with increased risk of readmission after adjustment (ORadj  =  1.16 [1.03–1.30]). Conclusions Admission to busy teams early in the year was not associated with increased odds of 30-day readmission, whereas admission later in the year to busy teams was associated with 16% increased odds of readmission.