Delivering higher quality, more compassionate healthcare at lower cost is a seminal challenge in healthcare today. While healthcare organizations around the country are implementing complex processes and technologies in attempts to achieve this often elusive goal, tremendous potential exists in "innovating around the obvious".
There are plenty of basic healthcare practices that could be changed to improve the patient experience, speed recovery from illness or injury, and lower cost. A recent success story is hospital infection rates, which have declined 17 percent from 2010, equating to roughly 87,000 lives saved and $19.8 billion in savings, according to the Agency for Healthcare Research & Quality.
Blood draws represent a procedure that is particularly ripe for change. These are the most common invasive medical procedure in hospitals worldwide: Roughly 760 inpatient draws are conducted every minute in the United States alone. The practice is also extremely important to delivering care; while it is difficult to define specifically, a commonly stated statistic is that laboratory results contribute to nearly 70 percent of clinical decision-making.
Despite their necessity, blood draws create tremendous disruption for patients and clinicians alike, and are associated with significant direct and indirect costs. Because they are a standard component of healthcare delivery, we tend to overlook the trauma, danger and waste that they create.
Recent practice data from four distinct U.S. health systems – representing 31 total hospitals – greatly informed and enhanced our understanding of this common but seldom-studied practice. These data, in addition to consistent data and evidence from other hospitals, health systems and research teams, have prompted us to explore the steps we can take to radically innovate this age-old practice.
Common and dreaded
The data collected from among our hospitals – along with two other leading U.S. hospital systems - demonstrate that inpatient blood draws are an incredibly common procedure: Twenty-two percent of patients received two or more draws per day during their admission, and 16% endured 10 or more draws during their hospital stay. This is consistent with previous data suggesting that 30% of non-emergency department patients receive 10 or more blood draws during admission and/or an average of at least 1.5 draws per day during their entire admission.
Unfortunately, this common procedure is also universally dreaded. Around 10% of the population holds a deep-seated fear of needles (trypanophobia) and 38% of children aged 3 to 10 years old must be physically restrained to endure a needle-based blood draw.
Making matters worse, 44% of attempts to draw blood from children fail and 43% require three or more sticks, while 16% require needle probing, or "fishing," to gain venous access. This situation is not much better for adults, with nearly 28% of venipunctures requiring more than one stick, according to 2009 research by Frost and Sullivan.
HCP safety and emotional impact
Patients aren't the only ones who suffer from blood draws. We know all too well that caregivers take on unnecessary risk from needles. Each day in the United States there are 200 needle-related injuries, and in one report, 70% of nurses working at 60 hospitals reported having experienced a needle-stick injury. These injuries and any resulting seroconversions take a physical and emotional toll, and have significant dollars associated with them: Studies suggest that needle sticks cost hospitals more than $5,000 per incident - or upwards of $50 million per year.
Additionally, while the "job" of drawing blood is often seen as relatively straightforward, the emotional dimension of this function is often overlooked. The emotional dimension deals with how the healthcare provider feels while conducting the job. When needle sticks create dread and anxiety among patients, it also creates anxiety for their caregivers. Nurses - who generally want to help patients feel comfortable and cared for - experience the negative emotional dimension of the blood draw because it is diametrically opposed to what they want for their patients.
Barrier to healing and health
Any hospital stay is certainly not without disruptions, from paging and alarms, to early morning and late night round for taking vitals. Data from our evaluation suggest that more than half of morning blood collections (52%) occur between 3 a.m. and 9 a.m. Waking a patient for a blood draw is a horribly invasive form of disruption, causing pain and anxiety when the patient should be resting to aid recovery.
Re-thinking the blood draw
Overhauling common, unpleasant medical procedures such as blood draws aligns with the purest definition of the "care" in "healthcare". Yet many providers today are focused on external mandates around regulations, outcomes and reimbursement. Sometimes it's easy to lose sight of the person in the middle: the patient. Reinvesting time and energy into how an organization can improve the patient experience speaks volumes about our commitment to compassionate care.
It's time for the healthcare industry to rethink blood draws with the goal of creating a more positive, safe experience for patients and caregivers. By doing so, we can improve the overall quality of healthcare delivery and move toward more patient-centric, compassionate care. As a consequence, we will improve patient and employee satisfaction, positively impact hospital VBP-based reimbursements, and reduce care-related inefficiencies.
The big picture: Addressing healthcare's most critical goals
Why target blood draws, and why now? Improving patient satisfaction and experience isn't just a feel-good endeavor; it connects to our healthcare mission of creating and maintaining healing communities. As well, healthcare organizations are being ranked and financially impacted by patient satisfaction through measures such as CMS HCAHPS scores. We can expect regulators to increase their focus on this area. Healthcare providers and payers alike are also seeing the effects of regulation on competition: With more choice in the market and increasing pricing transparency patients will go where they can get both the best value and the most compassionate service.
Finding a better way to draw blood is just one way in which healthcare organizations can put patients at the center of care delivery and at the center of all decisions.
Innovating the obvious
Re-imagining and then changing how blood draws are conducted can be tackled on multiple fronts:
1. Product innovation: First, we need to identify and evaluate new, value-based technologies that can replace or at least improve the current, flawed needle stick and CVC/PICC line draw procedures. Devices are being developed and tested that meet this requirement; one that holds great promise, approved by the FDA in early 2015, is a single-use disposable device that draws blood from an indwelling PIV catheter, eliminating the need for repeated needle sticks. Practitioners collect blood samples using evacuated tubes or a syringe and then, once all the tubes are collected, the device is disconnected and discarded.
Other recent innovations include vein visualization devices that help practitioners find patient veins using infrared technology.
2. Compassionate care: New products won't solve the problem entirely, however. It's worth the effort investigating programs and tactics to reduce patient stress from needles and other invasive procedures, such as relaxing music, artwork or even gentle massage before or during the draw. Researchers have looked at using counselors at the point of care to deliver visualization or other relaxation techniques. In addition, licensure and hospital practice policies need attention. Very often different personnel are drawing blood and measuring vitals, typically at different times, further interrupting rest and recovery.
3. Patient feedback: Current healthcare reforms focus on patient-centered care, which includes doing a better job of engaging patients in their own care and wellness and soliciting regular feedback. A program called the Patient Passport, developed by the National Quality Forum, is an easy-to-use vehicle for capturing patients' personal preferences; it uses pictures and simple language to help providers understand their patients as persons with stories beyond their illnesses and fears.
This kind of out-of-the-box thinking is exactly what's needed to provide compassionate and medically-effective care to patients. Blood draws are just one of the many common, obvious procedures we can improve on our journey to patient-centered care. Given the prevalence and importance of this procedure in the clinical setting, it's an area worthy of our attention, right now.
- http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2014.html?utm_source=HHSPressRelease65&utm_medium=HHSPressRelease&utm_term=HAC&utm_content=65&utm_campaign=CUSP4CAUTI2015
- Velano Vascular calculation based on data from Centers for Disease Control and 32 hospital partners
- Deacon B, Abramowitz J, Fear of needles and vasovagal reactions among phlebotomy patients, Anxiety Disorders 20 (2006) 946–960.
- Spagrud LJ, von Baeyer CL, Ali K, Mpofu C, Fennell LP, Friesen K, Mitchell J. Pain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access. J Pain Symptom Manage. 2008 Aug;36(2):173-84
- Laramie AK, Firsova N, Davis L, State Based Surveillance of Sharps Injuries among Hospital Workers, 2002-2004, American Journal of Infection Control, Volume 35, Issue 5, Page E166, June 2007.
- Cost of a high-risk accidental needle stick injury is approximately $5,144 per incident. Frost & Sullivan Economic Model, Version 3.1, 2007
- http://healthleadersmedia.com/content/FIN-308413/Better-HCAHPS-Scores-Protect-Revenue
- Andrews, G.J., Shaw, D., 2010. So we started talking about a beach in Barbados: visualization practices and needle phobia. Social Science and Medicine 71, 1804–1810.
About the authors:
Stephen Behm, MBA, is the director of Technology Management at University Hospitals in Cleveland, Ohio, where he leads the organization's efforts to commercialize medical technology developed by its clinical staff. He has more than two decades of industry experience in research, business development, marketing, and product development.
Todd Dunn is the director of Innovation at the Intermountain Healthcare Transformation Lab in Salt Lake City, Utah, which is working to cultivate innovation in the healthcare industry. Throughout his previous work experience at Cisco, Siemens, and GE, Todd has pursued innovative approaches to solving complex problems.
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