Journal of Anesthesia

, Volume 32, Issue 2, pp 198–203 | Cite as

Physician turnover effect for in-hospital cardiopulmonary resuscitation: a 10-year experience in a tertiary academic hospital

  • Tak Kyu Oh
  • You Hwan Jo
  • Sang-Hwan Do
  • Jung-Won Hwang
  • Jae Ho Lee
  • In-Ae SongEmail author
Original Article



Controversy exists as to whether the physician turnover affects patient outcome in academic hospitals. In-hospital cardiopulmonary resuscitation (CPR) is an important indicator of in-hospital mortality. This study aimed to investigate whether the physician turnover is associated with the in-hospital CPR rate.


This retrospective cohort study was conducted at a single center; all in-hospital CPR cases among in-patients from 1 January 2007 to 31 December 2016 were analyzed. The turnover period was defined as the changeover of the trainee workforce in March, May, and November. The primary outcome was any variation in the monthly in-hospital CPR events (per 1000 admissions). The secondary outcomes were return of spontaneous circulation (ROSC), CPR in intensive care unit (ICU), monthly in-hospital deaths per 1000 admissions, and average length of hospital stay.


A total of 2182 in-hospital CPR cases were included in the analysis. Monthly in-hospital CPR rates were greater during the turnover period when compared to the non-turnover period (4.66 ± 1.02 vs. 4.18 ± 1.56, P = 0.027). There was no significant difference in ROSC rate, CPR in ICU rate, monthly in-hospital deaths per 1000 admissions, or average length of hospital stay between the two periods.


Our findings indicate that physician turnover may be associated with in-hospital CPR rate. However, physician turnover was not associated with ROSC rate, rate of CPR in the ICU, in-hospital death, or length of hospital stay.


Education Resident Rapid response team Hospital utilization 



We express our deep appreciation to members of the rapid response team, the intensivists, and the CPR team. In addition, we would like to express my sincere appreciation to the professors of Emergency Medicine who inspired the idea of this study.

Author contributions

TKO contributed to the study design, and drafted the first manuscript; YHJ, SHD, JWH, and JHL contributed to the acquisition of data; IAS contributed to the study design and provided critical revision of the manuscript. All authors have given final approval for the final version of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors declared that they have no conflict of interest.


  1. 1.
    Young JQ, Ranji SR, Wachter RM, Lee CM, Niehaus B, Auerbach AD. “July effect”: impact of the academic year-end changeover on patient outcomes: a systematic review. Ann Intern Med. 2011;155:309–15.CrossRefPubMedGoogle Scholar
  2. 2.
    Mims LD, Porter M, Simpson KN, Carek PJ. The “July Effect”: a look at july medical admissions in teaching hospitals. J Am Board Fam Med. 2017;30:189–95.CrossRefPubMedGoogle Scholar
  3. 3.
    Saqib A, Ibrahim U, Patel P, Joshi A, Chalhoub M. Mortality among high-risk patients admitted with septic shock to U.S. teaching hospitals in July: does the ‘July Effect’ exist? Heart Lung. 2017;46:110–3.CrossRefPubMedGoogle Scholar
  4. 4.
    Myers L, Mikhael B, Currier P, Berg K, Jena A, Donnino M, Andersen LW, American Heart Association’s Get with the Guidelines-Resuscitation Investigators. The association between physician turnover (the “July Effect”) and survival after in-hospital cardiac arrest. Resuscitation. 2017;114:133–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Franklin C, Mathew J. Developing strategies to prevent inhospital cardiac arrest: analyzing responses of physicians and nurses in the hours before the event. Crit Care Med. 1994;22:244–7.CrossRefPubMedGoogle Scholar
  6. 6.
    Thiels CA, Hanson KT, Heller SF, Zielinski MD, Habermann EB. Assessment of patient-reported experiences of hospital care and the july phenomenon. JAMA Surg. 2016;151:879–80.CrossRefPubMedGoogle Scholar
  7. 7.
    Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med. 2004;59:1307–13.CrossRefPubMedGoogle Scholar
  8. 8.
    Schein RM, Hazday N, Pena M, Ruben BH, Sprung CL. Clinical antecedents to in-hospital cardiopulmonary arrest. Chest. 1990;98:1388–92.CrossRefPubMedGoogle Scholar
  9. 9.
    Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, Castle N, Crouch R, Ineson N, Shaikh L. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54:115–23.CrossRefPubMedGoogle Scholar
  10. 10.
    Levy K, Voit J, Gupta A, Petrilli CM, Chopra V. Examining the july effect: a national survey of academic leaders in medicine. Am J Med. 2016;129(754):e1–5.Google Scholar
  11. 11.
    Oh DY, Kim JH, Kim DW, Im SA, Kim TY, Heo DS, Bang YJ, Kim NK. CPR or DNR? End-of-life decision in Korean cancer patients: a single center’s experience. Support Care Cancer. 2006;14:103–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Sharma R, Jayathissa S, Weatherall M. Cardiopulmonary resuscitation knowledge and opinions on end of life decision making of older adults admitted to an acute medical service. N Z Med J. 2016;129:26–36.PubMedGoogle Scholar
  13. 13.
    Buist MD, Moore GE, Bernard SA, Waxman BP, Anderson JN, Nguyen TV. Effects of a medical emergency team on reduction of incidence of and mortality from unexpected cardiac arrests in hospital: preliminary study. BMJ. 2002;324:387–90.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Calzavacca P, Licari E, Tee A, Egi M, Downey A, Quach J, Haase-Fielitz A, Haase M, Bellomo R. The impact of rapid response system on delayed emergency team activation patient characteristics and outcomes—a follow-up study. Resuscitation. 2010;81:31–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Kim Y, Lee DS, Min H, Choi YY, Lee EY, Song I, Park JS, Cho YJ, Jo YH, Yoon HI, Lee JH, Lee CT, Do SH, Lee YJ. Effectiveness analysis of a part-time rapid response system during operation versus nonoperation. Crit Care Med. 2017;45:e592–9.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Anesthesiologists 2018

Authors and Affiliations

  1. 1.Interdepartment of Critical Care MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
  2. 2.Department of Anesthesiology and Pain MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
  3. 3.Department of Emergency MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea
  4. 4.Division of Pulmonary and Critical Care Medicine, Department of Internal MedicineSeoul National University Bundang HospitalSeongnamRepublic of Korea

Personalised recommendations