Looking for Statistic on Aneurysm Rupture Survival Rates

Bob Latino blatino at RELIABILITY.COM
Mon Apr 3 11:51:02 UTC 2017


Hi Karen

This is an interesting and timely statement for me.  I participate in the Human Performance Improvement (HPI) community as well.  This community advocates the learning from successes as well.  Being from the Reliability Engineering world myself for decades, the two (2) communities are in sych, as 'Reliability' is simply based on the concept of PROACTION or 'No Surprises'.

However, analyzing successes may seem easier to accomplish than failures, but I have not found that to be the case in my experience.

When investigating and analyzing failures, people tend to quickly distance themselves from being associated with the negative outcome.  This is for obvious reasons.  This is why sound evidence is the key to such an undesirable outcome. The evidence will lead us to the truth.

When attempting to investigate and analyze a 'success', people tend to flock to being associated with the success.  So it becomes difficult to determine where the credit is really due, and to what degree the actual participation played a role in the overall success.

Take for instance the Michael Colombini MRI death case that I discussed in a prior thread.  Let's say the MRI scan had no issues and was a 'success'.  In this case, how do we determine the realities of why it was a success?  I can see everyone taking credit under these circumstances, such as:


1.       the staff following procedures (and the procedures being deemed current and appropriate)

2.       facilities engineering for ensuring the alert systems monitoring O2 flow rates were operational and being monitored

3.       the OEM for the MRI equipment because it performed as designed and all PM's were current

4.       the housekeeping staff for ensuring there was no ferrous materials entering (or left in) the MRI suite after cleaning

5.       materials engineering for ensuring that no ferrous canisters were in the proximity of the MRI scanning room (allowing a potential mix up to occur)

6.       the training department for ensuring everyone was properly trained and qualified

7.       HR for ensuring they hired qualified personnel

8.       the power company for ensuring power was available

9.       security personnel for ensuring no one was in the MRI suite that wasn't supposed to be in there

10.   contract management personnel (of MRI suite) because they had all the bases covered in running the MRI business operation

11.   hospital leadership personnel because of their successful management of the contractors running the MRI suite

12.   Contracts/legal because their contracts between hospital and MRI contractors were sound

13.   O2 canister suppliers because their canisters met specifications

14.   and on and on

I know I am going overboard here a bit, but I wanted to make my point that when a 'success' occurs, everyone wants to take their part in the credit.  For this reason, it is not as easy to 'practically' determine the key elements of such a success.

Do not get me wrong, I am in favor of such recognition, as this is a proactive activity.  Looking at successes seeks to do so, in order to prevent failures.  I have just not been successful myself in applying this concept with any meaningful results.

The second hurdle to this 'success' concept is, it is hard enough to get the time to analyze a failure with the support of leadership.  There is always time pressure to do so and to complete it quickly.  It will get done primarily because there is a regulatory driver making them do it.  Just like any proactive activity (unfortunately), there is rarely a regulatory driver.  If it is hard to find the time and resources to investigate a failure properly, it will be nearly impossible to get the time and resources to properly analyze successes (where there is usually no urgency to do so).  Plus, as Karen states, there are way more successes than failures, so how do you prioritize which ones to analyze?

I am interested in learning who has applied this 'success' concept and how they have been able to measure their effectiveness, while overcoming these hurdles I described.

Thanks for bringing this up Karen.

Bob


Robert J. Latino, CEO
Reliability Center, Inc.
1.800.457.0645
blatino at reliability.com
www.reliability.com
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From: Karen Cosby [mailto:kcosby40 at GMAIL.COM]
Sent: Saturday, April 01, 2017 1:35 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG
Subject: Re: [IMPROVEDX] Looking for Statistic on Aneurysm Rupture Survival Rates

What is lacking in this discussion is that perhaps we have become so used to diagnostic errors that we forget that much of the time we actually do well.  This case is not an exception, just dramatic with a high potential for a catastrophic outcome.  It is good to celebrate and understand why they were successful, but also recognize that there is always great risk when the outcomes are so tenuous.

On Sat, Apr 1, 2017 at 12:12 PM, Mayer, Thom <tmayer at best-practices.com<mailto:tmayer at best-practices.com>> wrote:
Hi Bob

I'm an emergency physician who practices at a nationally recognized level 1 trauma center. Perhaps more importantly our oldest son, Josh, had a 5 cm basilar artery aneurysm so I know this territory fairly well and also discussed it with Josh's neurosurgeon

The answer on prognosis of brain aneurysms is, like so much in medicine, "It depends."  In this case it depends on the size and location of the lesion, the speed of recognition, the patient's underlying health status, and the skill and experience of not only the the vascular neurosurgeon and/or interventional radiologist ( both of which are specialties unto themselves) but the team of people caring for her, including the EMS/paramedics who instantly recognized she needed specialty care

For brevity's sake, the prognosis ranges from extremely high for small, focal aneurysms which can often be treated with coils through a catheter in which > 90% survival with no or minimal deficits in young people to nearly uniformly poor results for massive hemorrhages or large brain stem aneurysms (like Josh's-although his story is great as I ll share).

So I would say she is a very lucky young lady on every front but the kind of work the team did is actually extremely common.  As an aside, the team undoubtedly uses the principles of crew resource management as virtually all trauma centers do

And Josh's case was discussed by all of the best vascular neurosurgeons in the world. Only one, Dr Robert Spetzler of Barrow Neurological Institute, would even consider operating since the basilar artery feeds the brain stem and the entire artery was an aneurysm

Not to get too technical but he clipped BOTH vertebral arteries, diverting all anterograde flow through the collateral circulation creating retrograde flow, thereby keeping precisely the right amount of flow to clot the aneurysm but keep the basilar artery open. For the docs on the thread, that is a bold and stunning move that very few docs could pull off

And despite a sometimes rocky post-op course, Josh is 12 years out, married with 3 lovely daughters my wife and I enjoy every weekend!

Hope this helps

My best to your friend and his daughter

I rarely post but I enjoy the discussion

Best

Doc
Thom Mayer MD
Medical Director
NFL Players Association

Sent from my iPhone

> On Mar 31, 2017, at 5:14 PM, Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>> wrote:
>
> Good point!  How does the initial Dx of first responders (if at all) influence the initial Dx of the receiving ED physician, when time is of the essence?
>
> I didn't know if Neurosurgeons participated on this forum, but I thought I would check.
>
> Thanks
>
> Robert J. Latino, CEO
> Reliability Center, Inc.
> 1.800.457.0645<tel:1.800.457.0645>
> blatino at reliability.com<mailto:blatino at reliability.com>
> www.reliability.com<http://www.reliability.com>
>
>
>
> -----Original Message-----
> From: Hueth, Kyle D. [mailto:kyle.hueth at aruplab.com<mailto:kyle.hueth at aruplab.com>]
> Sent: Friday, March 31, 2017 10:42 AM
> To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>>; Bob Latino <blatino at reliability.com<mailto:blatino at reliability.com>>
> Subject: Re: [IMPROVEDX] Looking for Statistic on Aneurysm Rupture Survival Rates
>
> Wow! What a fortunate outcome.  I'm interested to hear the answer to your question and would like to pose another.
>
> Is there data on the appropriate initial diagnosis/evaluation by emergency responders when it comes to determining the level of care a patient will need, as was the differentiator in this case?  Outcomes tied to this early factor would be interesting to know.
>
> Best,
>
> Kyle Dean Hueth, MLS(ASCP)
> Healthcare Consultant
>
> Sent from my iPhone
>
> On Mar 31, 2017, at 05:45, Bob Latino <blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM><mailto:blatino at RELIABILITY.COM<mailto:blatino at RELIABILITY.COM>>> wrote:
>
> Two weeks ago, a good friend of mine's daughter suffered the rupture of an aneurysm at 35 y/o.  She was nonresponsive for 12 minutes and transported to our local Trauma 1 hospital which was about 40 minutes.  Brain surgery was performed within 8 hours of arrival at the hospital to put a stent in place.
>
> Amazingly she 1) survived, 2) will be released from the hospital tomorrow and 3) has no apparent deficits at this time.  She still has to take it very slow (she is very fit Physical Therapist) for about 4 months and has residual headaches which will reportedly fade in due time.
>
> Does anyone have any stats of the survival rates of such a traumatic event and to survive with no apparent deficits?
>
> The family is obviously overwhelmingly grateful to God and the hospital staff, but I was curious as to how uncommon it is to survive an aneurysm?
>
> This is related to SIDM in a sense because the initial belief was that she was having a seizure (epilepsy ran in the family).  They were going to transport her to the local hospital which would not have been able to properly treat a ruptured aneurysm (and the time delay likely would have killed her) in a timely manner.
>
> The Emergency Crew staff recognized the acuity of her case and decided to transport her to the Trauma 1 center a farther distance away.  Luckily it was the right decision.
>
> Thanks for any feedback on this question.
>
> Bob Latino
>
> Robert J. Latino, CEO
> Reliability Center, Inc.
> 1.800.457.0645
> blatino at reliability.com<mailto:blatino at reliability.com><mailto:blatino at reliability.com<mailto:blatino at reliability.com>>
> www.reliability.com<http://www.reliability.com><http://www.reliability.com>
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