BP Reading Accuracy

Thomas Benzoni benzonit at GMAIL.COM
Wed Feb 7 17:22:03 UTC 2018


Mr. Latino:

Your breakout is a good model.
To trace: The sphygnomanomter must be calibrated; we don't use mercury columns any more. Next time you have your B/P checked, look if the needle, before the cuff goes on your arm, rests squarely within the box? Most that I've seen are not calibrated. Added to this is the technology: Karotkoff sounds (the standard, from the days of mercury sphygs) v flow turbulence (automated cuffs.)

Human: does the person listening know what are Karotkoff sounds? Unlikely. Can they discuss whether we should use 4th or 5th? 

Admin: Are we reaching the right populations at the right time with the right diagnoses AND interventions? See paper from today @http://www.cardiovascularbusiness.com/topics/hypertension/clinic-readings-miss-56-percent-hypertension-cases-severely-preeclamptic-women (I'll send entire article if requested.)

Likely best: Risk-based screening by standard measure (establish likelihood of diagnosis.) Calibrate preferred monitoring measure against standard. Treat this chronic condition if found in primary environment (e.g., treat white-coat-hypertension by avoiding doctors, don't measure pressure on exercise runs, etc.)

So the group question is do we want quality at the base (high frequency, easy to screen and treat conditions with (relatively) low consequences (although I'm not sure about this last...)
 
tom 

Fearing no insult, asking for no crown, receive with indifference both flattery and slander, and do not argue with a fool. -Aleksandr Pushkin, poet, novelist, and playwright (6 Jun 1799-1837)

On Feb 7, 2018, at 6:11, Bob Latino <blatino at RELIABILITY.COM> wrote:

> I will offer a perspective from an outsider on how to explore how BP readings are not accurate and how they contribute to a bad outcome.
>  
> 'Inaccurate BP readings' is not the problem needing to be solved.  Not having accurate BP readings is likely a contributing factor to causing an undesirable outcome to occur (e.g. - harm and/or high risk near miss).  That is what catches our eye, when a bad outcome occurs, not the questioning of the accuracy of a BP reading when nothing goes wrong.
>  
> By asking 'How Could' past the Mode (M) level, we are seeking to break the problem down into digestible chunks.  How could a BP related condition not be detected? 
>  
> 1.       Equipment Related
> 2.       Human Related
> 3.       Admin Related
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> Now I am not a clinician and am not stating these hypotheses as being all inclusive (or even accurate), that is for you professionals to decide. I offer this example to show how to use logical deductive reasoning to think through why things go wrong.
>  
> 1.       Something could be wrong with the equipment (the stethoscope in this case). How could something be wrong with the equipment?
> 2.       It could be related to who is using the stethoscope.  Let's assume the equipment is fine, but the interpretation is not accurate.  How could this be?  
> 3.       It could be Admin related.  Let's assume the equipment is fine, the interpretation is fine, but the conveying of the accurate results falls in an administrative crack before reaching the decision-maker. How could that be?
>  
> This is obviously not complete, but I just want to show the questioning sequence that other industries use to reason out why bad things happen.  Each of these blocks have a 'verification log' that cites evidence to back up whether the hypotheses proved to be true or not, who collected it and when it was collected.
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> Bob
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> Robert J. Latino, CEO
> Reliability Center, Inc.
> 1.800.457.0645
> blatino at reliability.com
> www.reliability.com
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> 
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