pulse oximeter

Robert Bell rmsbell200 at YAHOO.COM
Thu May 17 18:41:02 UTC 2018


Yes, it seems as though solving the issues of blame and conflict is like finding cures for cancer, or understanding the ramifications of the micro biome. But surely we should be able to do it?! 

Do we have the brightest in the world?

Rob Bell

Sent from my iPad

> On May 17, 2018, at 10:33 AM, Tom Benzoni <benzonit at gmail.com> wrote:
> 
> If you're ever to get information on errors, there will have to be a culture change.
> And I'm not emperor of culture.
> 
> When ther'es an error, there is all sorts of talk about blame-free environment...and all fingers point to the doc.
> (I'm aware nurses are named but the doc is the big target.)
> When the error occurs, you see there is an "I" in "Team."
> 
> I work in a place that claims "blame free" but I do not see anyone stepping in front of the doc to protect her.
> I assume all on this list know of the trainee in Britain criminally charged over the death of a child.
> The parents were happy.
> The British Medical Society is concerned.
> The system is unchanged.
> 
> Tom 
> 
> 
>> On Wednesday, May 16, 2018, ROBERT M BELL <0000000296e45ec4-dmarc-request at list.improvediagnosis.org> wrote:
>> Thanks.
>> 
>> Yes, broken in every direction.
>> 
>> What to do?
>> 
>> Rob
>> 
>> 
>> > On May 16, 2018, at 6:55 PM, Behnke, Lyn <lbehnke at umflint.edu> wrote:
>> > 
>> > Blood pressure measurement is a terrible problem.  Weight measurement.  All those “basic” science issues are a challenge.  I do think, however, if we waited for the nation to adopt complete hospital error transparency we will all be dead and long gone.  Kaiser is doing an interesting program looking at billing issues and it is reported out on NPR.  That structure seems a little more benign, gets the messaging out and supports their research.
>> > 
>> > It is hard for me as a PCP who has moved to academia to listen to these stories day after day after day.  I admit, I tried going back into practice to do some simple things like medicare physicals, primary care in an Assisted Living situation and sports physicals.  I couldn’t be successful because I didn’t have access to the information that I needed to make diagnoses.  So, I gave that up and am doing acupuncture where I only have to depend on the patient.
>> > 
>> > The system is so broke.
>> > 
>> > 
>> > From: ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>
>> > Reply-To: Society to Improve Diagnosis in Medicine <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>, ROBERT M BELL <rmsbell200 at YAHOO.COM>
>> > Date: Wednesday, May 16, 2018 at 5:51 PM
>> > To: <IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
>> > Subject: Re: [IMPROVEDX] pulse oximeter
>> > 
>> > Thanks Ed,
>> > 
>> > There is the suggestion with your experience that it could affect management if not recognized.
>> > 
>> > If so, could SIDM focus on the tests we use for accuracy while waiting for the nation to adopt complete hospital error transparency, handle any negative image problems, and deal with litigation issues. And I think that there are even answers there.
>> > 
>> > I realize that as retired physician I am less conflicted and can speak a little more strongly. Which brings up the question of how to deal with this conflict for the sake of our patients?
>> > 
>> > Not easy,
>> > 
>> > Rob
>> > On May 16, 2018, at 12:25 PM, Ed Hoffer <ehoffer at gmail.com<mailto:ehoffer at gmail.com>> wrote:
>> > 
>> > In my office it was obvious - either no reading at all or obviously false (O2 sat of 80 in patient pink and in distress). I found simplest was to have them sit on one hand for few minutes while I examined other parts. Rarely needed hot water.
>> > Ed
>> > Edward Hoffer MD, FACC
>> > Sent from my iPhone
>> > 
>> > On May 16, 2018, at 1:06 PM, ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>> wrote:
>> > Thanks. How many HCPs do you think know that?
>> > 
>> > Is there a formal recommendation to warm the hands/limb if cool to get an accurate reading?
>> > 
>> > What is the average error if not warmed and is that, in some patients, big enough to make the wrong decision in management?
>> > 
>> > Rob
>> > On May 15, 2018, at 6:39 PM, Behnke, Lyn <lbehnke at UMFLINT.EDU<mailto:lbehnke at UMFLINT.EDU>> wrote:
>> > 
>> > Yes, Dr. Bell, the temperature of the limb affects the pulse oximeter reading.  Cold hands, lower O2 saturation.  That has been true in my practice, however, there is also literature to support warming up the hands before using the oximeter.  Other solutions:  Ear clips (expensice) and adhesive trips that go on the forehead held by headbands.
>> > 
>> > With warmest regards,
>> > 
>> > Dr. Lyn Behnke, DNP, FNPBC, CAFCI, FAAIM, CHFN
>> > Assistant Professor of Nursing
>> > School of Nursing
>> > University of Michigan - Flint
>> > 2180 William S. White Building
>> > 303 E. Kearsley Street
>> > Flint, Michigan 48502-1950
>> > 
>> > Office phone (810) 762-3451
>> > Fax (810) 766-1950
>> > 
>> > lbehnke at umflint.edu<mailto:lbehnke at umflint.edu>
>> > 
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Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine


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