Letter from the Editor

This issue examines the “July effect,” readmission prevention, blood glucose management, and more.

The “July effect” is well known in medicine. But is the notion that medical mistakes spike when students become interns actually based in fact? Recent research suggests it may be, at least as far as medication errors go. A June 2010 article in the Journal of General Internal Medicine found that, over almost 30 years, fatal medication errors jumped 10% in July in U.S. counties with teaching hospitals. While some experts say more evidence is needed that this change is a direct result of the influx of new residents, virtually all agree a smooth transition for new physicians is crucial. As such, facilities have ramped up orientation programs, beefed up staff, and enhanced supervision during this period. Charlotte Huff's cover story discusses the details of these efforts to create seamless care, no matter what the calendar says.

Much has been researched and written about how to prevent readmissions. Yet the Institute for Healthcare Improvement (IHI) has still managed to find a new angle to the problem: getting the patient's perspective on why a hospital return happened. We take a look at the institute's new initiative, the State Action on Avoidable Rehospitalizations (STAAR), which encourages interviews with patients and their families as a way to shed light on readmission precursors. The information is then used to revise hospital procedures—such as those surrounding patient education—so that readmissions under similar circumstances might be prevented in the future.

Speaking of long-standing issues, Stacey Butterfield takes a look at blood glucose management now that a new guideline on intensive insulin therapy for inpatients has been released by the American College of Physicians. Read her Q&A with Amir Qaseem, FACP, director of clinical policy at the College. Insulin management is also the topic of our MKSAP quiz. In other clinical news, one feature talks about diagnosis and management of obstructive sleep apnea, while our Coding Corner column discusses the importance of documenting BMI. Last but not least, our Expert Analysis covers cholesterol embolism syndrome.

As always, we welcome your feedback on this or any other issue. Please write to us.

Jessica Berthold
Editor, ACP Hospitalist