SHM Converge Scientific Abstract ePoster Gallery-Defying the July Effect: A Bundled Innovation During Residency Launch at the Nation's Second-Busiest Ed

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This abstract examines whether the “July Effect” necessarily harms hospital efficiency when a new residency program starts. At a 910-bed hospital with the nation’s second-busiest emergency department, an internal medicine residency launched in July 2023. To prevent disruption and improve throughput, the hospital introduced a four-part bundled intervention: a dedicated admitting service with hospitalists and residents, geographic cohorting of patients, structured multidisciplinary rounds with discharge barrier checklists, and real-time dashboards showing length of stay and bed availability.<br /><br />Using a pre-post, risk-adjusted analysis of 11,619 consecutive internal medicine discharges from January to November 2023, the authors compared outcomes before and after the residency launch. The post-launch period included 5,427 discharges, while the pre-launch period included 6,192. Adjustments were made for season, comorbidity, acuity, insurance, and admission source.<br /><br />Results showed that average length of stay decreased from 4.73 to 4.24 days, a 15% reduction that was statistically significant. Readmission rates remained essentially unchanged (14.4% vs 14.7%), and mortality also stayed stable (0.9% vs 0.8%). The improvement in throughput translated to approximately 3,800 bed-days freed annually, with a potential financial benefit estimated at $3–5 million. Resident satisfaction was also high.<br /><br />The authors conclude that, with the right system design and leadership support, launching a residency program can improve both education and operational performance rather than causing decline.

Asset Subtitle

Luis Daniel Lugo

Meta Tag

Author List Anas Bizanti, Heena Mansuri, Luis Daniel Lugo, Nancy Finnigan, Sai Wan, Zoya Khan

Category Innovations

Concept July Effect

Concept Bundled Intervention

Concept Length of Stay

Concept Residency Program Launch

Concept Risk-adjusted Pre-post Analysis

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Luis Daniel Lugo

Track Quality Improvement

Keywords

July Effect

residency program

hospital efficiency

length of stay

patient throughput

internal medicine

bed availability

multidisciplinary rounds

readmission rates

risk-adjusted analysis

July Effect

Bundled Intervention

Length of Stay

Residency Program Launch

Risk-adjusted Pre-post Analysis