CEO Summary: Based on patient satisfaction surveys done across the United States, Press Ganey Associates, Inc., reports that “lab” is ranked near the bottom of 10 clinical services. Source of these low satisfaction rankings is phlebotomy, since most patients find needle sticks uncomfortable and some even have a fear of needles. To raise patient satisfaction scores, hospital CEOs are now willing to spend money on phlebotomy products that improve patients’ experience with blood collection.
PHLEBOTOMISTS IN THE HOSPITAL have often felt like the late comedian Rodney Dangerfield, who regularly complained that “I don’t get no respect!” However, phlebotomy services are gaining new attention from hospital CEOs and administrators.
This turnabout in recognition for phlebotomy’s contribution to hospital care is due to the twin trends of improving patient safety and measuring patient satisfaction. As hospitals measure their performance against specific patient safety and patient satisfaction measures, phlebotomy services have surfaced as a major source of improvement.
This is particularly true in the area of patient satisfaction. National surveys consistently show that patients rate their lab experience, including phlebotomy, among the least satisfactory in the hospital and that millions of patients are highly uncomfortable about having their blood drawn. Many have blenophobia, a fear of needles.
Discomfort From Needle Pain
Further, it is an area ripe with opportunity for improvement. More than 350 million blood samples are collected annually in the United States. One study found that about 40 million patients experience high discomfort because of needle pain.
As hospital CEOs and administrators pay closer attention to patient satisfaction surveys, they are recognizing phlebotomy services as an area that holds great potential to improve how the patient views his or her total experience at the hospital. Press Ganey Associates, Inc., of South Bend, Indiana, which provides measurement and improvement services to hospitals across the country, notes that dissatisfaction with phlebotomy is often highlighted by patients in these surveys.
“In today’s healthcare environment, competition among hospitals is increasingly fierce and the patient’s opinion is becoming much more prominent,” said Matt Mulherin, Director of Corporate Communications for Press Ganey in an interview with THE DARK REPORT. “We have national data related specifically to outpatient procedures such as blood work, which is so common in healthcare. In fact, blood work is critical because of the sheer volume and frequency that it happens. Most patients will need to have blood drawn at some point, either during an outpatient visit or during a hospital stay.
“But while a blood draw might be routine for hospital and lab professionals, among patients there’s a lot of fear and anxiety,” added Mulherin. “Many patients are uncomfortable with needles, and these factors make the interaction between clinicians and patients critical.”
Recent analysis by Press Ganey shows that patients rated their experience with the laboratory, which includes phlebotomy, as being the least satisfactory among outpatient procedures. Among 10 areas of care, patients rated satisfaction with laboratory services lowest, Press Ganey analysis shows. Press Ganey reports that, on average, only 72.8% of patients perceived their care from the laboratory as “very good.”
Hospital CEOs and administrators are recognizing the role that phlebotomy can play in lifting the overall patient satisfaction scores of their institutions. One strategy is to centralize phlebotomy services so that trained phlebotomists have responsibility for blood draws. (See TDR, October 29, 2007.)
A second strategy finding favor is to spend money to purchase products designed to help patients undergoing venipuncture. The willingness of hospitals to invest in such products is another sign of how phle- botomy’s connection to patient satisfaction has caught the attention of hospital CEOs and administrators.
This product category is growing rapidly, and many lab directors and pathologists are unaware of this phenomenon. Companies are selling products and tools that aid the phlebotomist in the actual venipuncture, as well as topical anesthetics and similar pain-relieving products. These products all have the same goal: to improve the phlebotomy experience of patients.
The VeinViewer, manufactured by Luminetx Corp., of Memphis, Tennessee, shines a light on a patient’s vascular system.
According to Luminetx, VeinViewer allows medical professionals to locate subcutaneous vasculature and project real-time images directly onto the surface of the patient’s skin.
Using VeinViewer, a phlebotomist or other clinician can map a patient’s vasculature regardless of age, body type, or skin tone. Luminetx claims the technology is a safe, non-invasive adjunct technology for clinical treatments and procedures including, but not limited to, IV insertion, routine venipuncture (for blood sampling), and PICC-line insertion.
Some hospitals now use LidoSite, a fast-acting topical anesthetic from Vyteris Inc., of Fair Lawn, New Jersey, that works in as little as 10 minutes. Introduced in 2005, LidoSite delivers lidocaine and epinephrine to the puncture site through a skin patch boosted by electrical current from a battery-powered device.
Another product designed to improve the experience of venipuncture is Synera, manufactured by Endo Pharmaceuticals, of Chadds Ford, Pennsylvania. It is a self-warming, “peel and stick” skin patch containing lidocaine and tetracainea, designed for use by patients three years and older.
It was recognition of patients’ fear of needles that encouraged the Barbara Davis Center for Juvenile Diabetes at the University of Colorado Health Sciences Center to take active steps to improve venipuncture. Michelle Hoffman, R.N., Clinical Coordinator for the Daisy Study and the Teddy Study at the center, said, “In our work, we do a lot of needle sticks and almost all of them involve children. We have used VeinViewer since August (2007). In our research studies, we have about 1,600 patients ranging in age from 3 months to 18 years.
“We use the VeinViewer with a patient sitting in a phlebotomy chair or in a bed,” Hoffman said. “The light source can be used on either side of the body and it shows the vasculature. Also, the phlebotomist sees what direction the veins are going in and whether there might be a bifurcation or a sudden change in direction. Seeing the veins in this way helps the phlebotomist discern the best stick point and the best angle. Our experience is that this device enhances the phlebotomist’s skill.
“In the center, our research involves children and young adults who have Type 1 diabetes. We are also conducting multiple research studies on other autoimmune diseases related to diabetes, such as rheumatoid arthritis, lupus, and heart disease,” she said. “We’ve revised our phlebotomy procedures to improve the experience for the patient.
“First, we use a lotion that is a topical anesthetic,” described Hoffman. “Next, the VeinViewer is used because that guides the phlebotomist to the location of the vein and allows us to stick most patients only once. Little children have small veins, which sometimes makes it difficult to find a vein by feel or by sight. Using the VeinViewer lets us see the best veins quickly.
“In our research studies, this tool is invaluable because our studies are based on doing repeated blood tests throughout the year,” Hoffman added. “For some patients, we have to do the tests one to four times each year and we want families to keep coming back each time to continue in the study. Some of the children in the study don’t have diabetes, but they are at risk. So it’s invaluable to us to make each of the blood draws fast and easy and less traumatic.
Positive Patient Reaction
“So far, reaction from the patients has been positive,” she said. “Kids think it’s cool because they can see their veins, which makes taking a blood sample almost like a science lesson. They think it’s awesome. Also, parents appreciate that we are using technology like this to make it easier for their children to participate. We know that if their kids are unhappy, parents won’t bring them back. If kids are happy and if the parents see that we’re doing everything we can to make this easier for their kids, then they’re more likely to trust us long term.”
The Barbara Davis Center does not yet have data on what effect the VeinViewer has had on patient satisfaction. Nonetheless, Hoffman recognizes the value of having high patient satisfaction scores. “Patient satisfaction is incredibly important because the more satisfied the patients are, and the more satisfied the families are, the more likely they are to continue to participate in our long-term studies,” she explained. “Long-term data is what’s important to us. But patient satisfaction data is important to any hospital because once you have patients, you want to retain them.”
Boosting Satisfaction Scores
THE DARK REPORT observes that as hospitals focus more on patient safety and patient satisfaction, they recognize the value of having the highest levels of customer service for every patient encounter. In some hospitals, the importance of phlebotomy can be overlooked, but it is, in fact, an opportunity to reduce specimen rejections and improve patient satisfaction while also reducing liability risk and improving patient care.
The increased attention that hospital administrators now give to phlebotomy is an unexpected consequence of the patient safety movement. On the other hand, it shows the power of measuring outcomes and patient satisfaction to drive improvement across all areas of healthcare. Who would have predicted, earlier in this decade, that one consequence of patient satisfaction surveys would be projects and investments to improve the quality of phlebotomy services!