Drawing a new patient experience

A panel discussion on enhancing the patient and clinician experience with innovations in phlebotomy blood collection

Over the last several years, patient-centric decision making has grown as an important driver of clinical and financial outcomes for healthcare institutions. BD Life Sciences believes that the blood collection process has significant impact on the overall patient experience, and in an effort to increase awareness and encourage dialogue, we brought together seven industry experts to share their unique perspectives in a roundtable discussion. On May 20, 2016, they convened in Dallas to talk about the issues of phlebotomy that impact patients, clinicians and organizations.

Panelists

Kathleen Becan McBride, EdD, MASCP, MLS (ASCP), is a former Professor in the Department of Family and Community Medicine at the University of Texas Health Science Center at Houston (UTHSCH) and Director of UTHSCH Workforce and Resource Development in Houston, Texas. She is co-author of the book Phlebotomy Handbook.

Diane Cope, PhD, ARNP, BC, AOCNP, is a Nurse Practitioner at Florida Cancer Specialists & Research Institute in Fort Myers, Florida.

Robert Del Guidice, MBA, MT(ASCP), DLM, FACHE, is the Clinical Administrative Director of Pathology and Laboratory Medicine at the University of Texas MD Anderson Cancer Center in Houston, Texas.

Frederick Kiechle, MD, PhD, FCAP, is the Medical Director of Clinical Pathology at Memorial Healthcare System in Hollywood, Florida.

Matt Ostroff, RN, BSN, CRNI, VABC, CPUI, CEN, is a Vascular Access Coordinator at St. Joseph’s Hospital in Paterson, New Jersey.

Mark Rowe, RNP, MNSc, VA-BC, is a Vascular Access Specialist at the University of Arkansas at Little Rock, in Little Rock, Arkansas. He was President of the Board of Directors for the Association for Vascular Access in 2014–15.

Airica Steed, EdD, MBA, RN, CSSMBB, FACHE, IASSC, is the System Vice President and Chief Customer Experience Officer (CXO) at Ohio Health, in Columbus, Ohio. She is an Executive Board member of The Beryl Institute.

The discussion was moderated by Ana Stankovic, MD, PhD, MSPH. She is the Worldwide Vice President of Medical Affairs at BD Life Sciences in Franklin Lakes, New Jersey.

How does the patient experience make a difference to your institution? What can be done in the area of phlebotomy to improve the patient experience? Airica Steed

In my institution, it is imperative to go well beyond just patient satisfaction because it’s not about the smile on the face, it’s about the entire experience—every touch point, every interaction. In order to really understand the patient experience, we need to understand what drives the patient experience, and more importantly, move away from those key areas that are causing disservice and disruption. To do this, we need to ask the following: If we are providing this service, are we able to provide it in the best way possible? How do we eradicate any barriers and roadblocks as it relates to the blood collection process, such as wait time to collect and wait time to actually receive the results? How do we address the fact that blood collection from the perspective of the patient is seen as highly disruptive? How do we make the blood collection process much more compassionate, and much more effective with high quality? How do we avoid all of the errors and redundancy in variation that’s provided within the process?

Robert Del Guidice

We measure the patient experience using the Press-Ganey tool for both our inpatient and outpatient environment. Although it is very difficult for the patient to actually measure the quality they receive, their perception of the quality is very true. They are aware how friendly or how courteous the person is that is going to stick that needle in their vein, and that’s very important. It’s more than just a smile; it’s empathy for that patient. It’s getting a good blood specimen with good results. For one of our quality measures, we measure the entire wait time—from when the patient arrives until the laboratory result is on the chart. We break up wait time into three sections: 1) the wait time from when the patient arrives until we have the blood specimen in the tube labeled and properly identified, 2) how long it takes to transport that specimen from the collection area to being received in the laboratory, and 3) once it’s in the laboratory, how long it takes to be processed with the end product being a viable result. The clinicians value total wait time.

Mark Rowe

Anything we can do to decrease a patient’s perception and actual feeling of pain is always important. Improving the products that we’re using and anything to take the stress away is always there. I always tell my patients, “You have control of this procedure and if at any time you say stop, I stop.” So, I turn it over to them too because pain is subjective. I can’t tell you the pain you feel. You tell me the pain you experience. We have to remember this whenever we’re doing procedures.

Airica Steed

It is important to ensure that you have the right systems in place that will assure minimal variation, minimal inconsistency and proper education. We measure patient experiences with a multitude of factors. One, we have government mandated measures that we have to embrace. It goes well beyond hospital CAHPS. Most organizations actually employ a survey methodology where they capture patient voice either real time or through mail. Other organizations track patient complaints, and there’s a lot that’s centered around the blood collection process. That overall process, really hearing and heeding what the voice of the customer is actually telling us is very important to measure. Collecting statistics around quality—number of hemolyzed specimens, number of times you have to redraw, when do you actually collect, what’s the turnaround time of not only collection but results turnaround? What’s the impact of those efficiency measures on overall length of stay and other barriers to the quality of care, impact on quality outcomes such as infections and other factors? We can take a real-time glance of what the voice of the customer is telling us through patient experience forums and patient and family advisory councils and various focus groups.

Matt Ostroff

Patient experience is impacted by technique, the technique with any device. For example, when we train our phlebotomists, they are surprised to learn that if they stick the patient when the alcohol is still wet on the skin, it’s going to sting, but if it dries it doesn’t sting. The phlebotomy experience affects the patient’s perception of the quality of care that they receive. Phlebotomy technique, such as the angle of entry, getting a clean entry without fishing or probing or creating a hematoma, plays a big role in that patient’s perception.

How does the need for patient satisfaction in phlebotomy impact reimbursement? Matt Ostroff

Well, reimbursement-wise, most patients in a hospital are bundled under a DRG. Whether we use fifty phlebotomy needles on you or one, we’re going to get the same reimbursement for that procedure or for that patient stay. Accuracy and first-attempt success is huge in supplies.

Airica Steed

When talking about the impact of this practice on reimbursement, three words come to mind: value-based care. No longer are we getting paid based off of volume of services. It’s tied to patient experience. It’s tied to patient outcomes. It’s tied to cost, and it’s tied to the quality of the entire experience. More than 70% of your interactions are tied to the blood collection process. It most definitely has a heavy impact on the patient experience, has a heavy impact on quality, has a heavy impact on outcomes and it most definitely has a heavy impact on cost.

Frederick Kiechle

Data drives change in healthcare more than anything else, and if you were to write, or a group of people were to get together and write a review article showing what it costs to do it one way and how you’ve changed and altered the cost by doing it a different way, and calculate an ROI (return on investment), administrators would take interest. What we’re doing is looking at a cost avoidance model for avoiding the additional cost of professional time as well as supplies. All those things have to be added together as a total cost analysis.

Robert Del Guidice

The patient and their family also drive where they want to have their medical procedure done, and that drives reimbursement, If a patient doesn’t want to go to a specific place because they had a bad interaction with a specific person or they did not like the way the blood collection or any procedure was done, it’s going to drive to some extent where they may choose to have their procedure done, which is large dollars. The patient preference plays a big role to this and something as simple as the needle selection in making the patient feel comfortable at that simple procedure of phlebotomy can contribute to this whole effort.

In the current phlebotomy practice that you have, what are the biggest areas that actually increase your cost of phlebotomy? Robert Del Guidice

One of the biggest is rework. If we have to re-stick the patient, we have to spend labor, equipment, supplies and additional turnaround time to re-collect a specimen because the first collection was not acceptable. This will double or triple our cost.

Frederick Kiechle

It’s screening of the specimen, when we do collect the specimen, specimen processing analyses. Is there hemolysis present? Is that specimen going to yield a good result? It’s really a cost avoidance story you’re trying to paint, and you want to also remember that when you do a cost analysis, you need to look at what happens when phlebotomy is done inappropriately, and you have poor samples coming to the lab. What does that mean to the lab? How much extra time does it take in the lab?

Robert Del Guidice

Nobody’s going to say, “Well, you avoided that cost, what a great job.” They look at how much money you’re spending and how much can you reduce. It’s very hard to quantify or to get credit for the cost avoidance. What the real measure needs to be is the outcome. Through all the process improvement, through all the efforts, better specimen quality, better supplies, how much have we improved the process that the final product, the outcome, the patient outcome is significantly better. Some of that will be attributed to cost avoidance, although it’s going to be very hard to pin an accurate number on that, although we know that there are tremendous savings made through cost avoidance.

Airica Steed

Another cost dynamic that wasn’t really touched on is the penalties of a bad process. These include several penalties right now from the government on outcomes, as well as patient experience that actually factors into this. So, a bad stick may result in a cost penalty from the government, from the commercial payers, and from other entities.

What are the characteristics that make difficult venous access collections so challenging? Mark Rowe

For any of our patients, you take a 500-bed hospital, you have a list of what we call the difficult patients—morbid obesity, scleroderma—and we just go down the list. At any of our institutions, we have every one of those patients in our beds at any given time. It’s almost every patient that comes into our system now potentially has bad veins, and we have to set up a system to handle every one of those patients.

Diane Cope

In our oncology setting, venous access is necessary for both blood draws and giving treatments. Venous access characteristics include actually finding the vein—is there any visible access—and the quality of the vein. Not only does it have to be a good quality vein, it has to be safe for us. We’re giving vesicants and irritants, and so a vein has to uphold very dangerous types of medications.

Matt Ostroff

I really think that for setting yourself up for success, it’s about finding the right vein. Reach the right vein, the right time. Specifically for a success in devices, you need to look at which one of these devices is going to get you what you need, and you do not have only one tool. You need a set of tools in your backpack. If I need ten tubes, I need something that’s going to stay in the vein when I move or if the patient moves.

How does device selection enable difficult venous access? Kathy Becan McBride

There are so many patients that aware of blood collection sets. They’ve had a collection already with them, and they’re coming in requesting a specific set. If you come in with a straight needle, they don’t want it. They want the blood collection set because they have less pain. I think organizations are really listening to patients right now. If the patients are going to be continually in pain with poor success on getting blood samples, and the procedure has to be repeated for one blood sample, administrators and organizations are going to listen to that.

Robert Del Guidice

We use 100% wingsets. We do not use straight needles at all, given our oncology patient population. Yes, it adds to the cost, but it gives greater patient satisfaction and much more success in getting the specimen. Also, phlebotomists at other institutions that have a choice between a straight needle and a wingset will prefer the wingset. It’s much easier to use, gives greater ease of access and is a little more forgiving.

What is your perception of the device [described above], and how may this device offer a solution to issues such as patient pain, successful sticks, sample quality and efficiency? Diane Cope

The study results are very impressive. I’m impressed by the smaller gauge for our patient population with difficult vein access. It would be extremely helpful with that fill time to get an adequate sample without hemolysis issues. Pain reduction, smaller gauge for difficult and thin veins, and getting an adequate sample the first time are important in our setting.

Mark Rowe

The bevel technology is always something I’m interested in, because it deals with a lot of our drag that we’re going through, so it was impressive to see that. I’d like to actually feel it in action also. I’m impressed especially with the penetration force decrease and the shorter fill times.

Airica Steed

The product seems to cater to the patient experience. How does this product—outside of the time factor—how is it aligned with outcomes such as reduction in the probing and fishing, the reduction in re-draws, the direct correlation with more difficult sticks?

Matt Ostroff

From my experience, the only thing that patients feel is the initial tip going through the skin because once you’re passed that, that pinch is pretty much over and you can get into the vein. So having a better bevel, a sharper bevel with five different angles to it seems to me like it would be a really smooth, nice insertion, and just the psychological aspect of being able to tell them that we are using the smallest needle on the market. I think the needle is fantastic, and I like the push button because right now I don’t have that, so I really like that patient safety aspect.

Frederick Kiechle

Well, again, I’m very impressed. It’s sort of an obvious sort of solution to a longstanding problem, so my curiosity is how come we didn’t do this a long time ago?

Robert Del Guidice

The smaller gauge size certainly would reduce the entry pain, and the smaller diameter is a big plus. The lumen size with the tube fill is fantastic, that the 23 will fill as quickly as the 21 filled, and it certainly does not contribute to additional hemolysis, which is a plus, and hands down, the staff safety with the push-button technology is nice.

If you were to introduce this blood collection set into your organization, what would be the impact that you could expect to see for your particular role, for your organization and for the patients themselves? Robert Del Guidice

Well, I think the product would certainly be well received by the patient. I would also do a little demonstration. If it really did increase patient satisfaction, if it could be that much—the painlessness, if it really could be demonstrated and be proven. I think it would be well received in the institution.

Kathy Becan McBride

I would compare this particular new device to what you’ve had previously, focusing on the differences in the needle design and showing that they lead to better patient satisfaction.

Matt Ostroff

Technology and devices enable a clinician to improve. At the end of the day, the patient’s experience is impacted by the clinician behind the needle technology. I do think it will reduce pain. I think the way I would pitch to my hospital is to promote that hospital’s use of the device as a differentiator from competing hospitals.

BD Life Sciences has introduced a new safety blood collection set—the BD Vacutainer® UltraTouch™ push button blood collection set—that uses proprietary needle technology to help enhance the patient experience during this important procedure. The BD Vacutainer UltraTouch push button blood collection set employs patented PentaPoint™ comfort 5-bevel needle technology to help reduce the chance of a painful insertion by creating a flatter, thinner surface to help penetrate the skin with significantly greater ease, and BD RightGauge™ technology, which increases the needle’s inner diameter and enables clinicians to select a smaller gauge needle without sacrificing sample quality and blood flow.* The device characteristics, benchtop and clinical data were presented to the roundtable panel.