Putting patients first during blood collection

Aug. 17, 2013

Successful healthcare institutions understand the value of high patient satisfaction in a competitive marketplace and tough economic climate. Few patients look forward to medical care, and perhaps even fewer know what to truly expect while receiving it. Yet almost all patients and their family members have basic expectations about what constitutes competent, comfortable care and good customer service.

Institutions that exceed these expectations increase the likelihood patients will elect to return for future healthcare needs, as well as recommend them to others. For those providers that fall short, their reputations and financial well-being suffer. While the importance of word of mouth is nothing new, the explosion of social media and consumer-oriented healthcare websites is amplifying its effects. Patients and their families now have multiple ways to express their pleasure or displeasure for millions to see. Combine these communications outlets with government reporting of quality metrics, and prospective patients can quickly form opinions without ever setting foot in a healthcare facility.

This trend is compelling many institutions to rethink patient satisfaction and the entire patient experience. With a proactive mindset, they seek to enhance every patient interaction. They go beyond cleanliness and the taste of cafeteria food to focus on more discrete, but equally important, touch points, such as phlebotomy.

Blood collection is one of the most high-touch procedures that patients undergo, as clinical laboratory testing influences an estimated 70% of all medical decisions.1 It is typically one of the first interactions a patient has with a hospital’s clinical staff, and it is perhaps the one procedure that almost all hospital patients will likely undergo during their stay.

New research suggests that it takes only one bad blood-draw experience to decrease patient satisfaction. These new data from American Opinion Research were derived from a comprehensive survey of more than 200 patients who had their blood collected at least three months prior to the survey. Most had multiple procedures in the year prior to being interviewed.   Nearly 70% of respondents had blood collected in a hospital setting.2

The results illustrate that blood collection can be a source of significant anxiety for patients even when the procedures go well. Unfortunately, it also shows how many of these procedures can go wrong.  More than three out of four respondents reported having a clinician experience difficulty drawing their blood. Of patients who experienced a difficult blood draw, 95% said a second stick was required. Almost 90% of these patients suffered bruising, and 84% felt more pain.2

With these results, it is not surprising that almost 8 in 10 patients surveyed said their blood collection experience influenced their satisfaction with a hospital.  In fact, the procedure ranked among the highest influencers of patient satisfaction, and an overwhelming majority of patients believed it should be measured on patient satisfaction surveys.2

Given these results, it is critical for hospitals and laboratories to look for ways to make the procedure more comfortable for the patient.  One of the most basic measures is to make sure phlebotomists and nurses have the right tools for the job, which means the ones that they are most confident using, that afford them the most needlestick injury protection, and that patients prefer.

The patient survey also explored what types of blood collection devices patients preferred.  First, the survey showed respondents an image collage of devices commonly used to draw blood, without any verbal or written descriptions to avoid biasing their answers. One device emerged as a favorite. Nearly 40% of patients preferred having their blood drawn with wingsets—more than any other device. After getting brief descriptions of the various devices, the respondents were asked which device they would choose for themselves or loved ones. Almost 6 in 10 said they would prefer wingsets over blood collection needles or other devices.2

The reasons behind this preference show how using these devices could help yield a more pleasant experience. Patient respondents perceived that wingsets:

  • Create less bruising and pain
  • Appear less scary
  • Go in/come out easier
  • Deliver better first-stick success

In a separate survey of 200 phlebotomists and nurses fielded at the same time, many clinicians seemed to agree. Almost half preferred to use wingsets for blood collection procedures, citing a better patient experience, especially for those with delicate or fragile veins.3

While the results show a preference for wingsets among patients and clinicians, access to these tools is often restricted. Formal programs or policies exist in some healthcare settings to reduce wingset usage based on perceived issues over needlestick safety or sample quality, with limited data to support these concerns. The concerns are genuine and raise debatable points. When comparing the safety of wingsets to other blood collection devices, however, it is important not to generalize.

Different types of safety mechanisms offer different levels of protection. For example, clinical studies have demonstrated that wingsets providing in-vein activation via retracting needles offer better needlestick protection than first-generation forward-shielding safety mechanisms,4 and they achieve better activation rates. Lumping together the two generations of safety devices can lead to a flawed assessment.5

Any attempt to compare the sample quality from one blood collection device with another must look beyond just the devices being assessed. Such studies must take into account other variables such as patient condition, phlebotomy site, clinician skill levels, procedures followed, and specimen handling, and transportation. All of these play a role in hemolysis and other sample quality problems. Few published studies have done this.

An internal clinical study was recently conducted to assess the quality of specimens collected with safety wingsets and straight blood collection needles. Samples from 31 healthy adults were evaluated for hemolysis, as well as selected chemistry analytes, prothrombin time (PT), activated partial thromboplastin time (aPTT), and complete blood count (CBC) parameters. In addition, the study  looked at potential clot formation or activation in anticoagulated specimens. The results demonstrated clinical equivalence between the two devices across all selected analytes. As for hemolysis and clot formation, no statistically or clinically significant difference existed between the two device types.6

One aspect that needs further exploration is whether a specific device is better for certain types of patients, such as the elderly or children. The clinician preference surveys cited earlier indicate that clinicians have a strong preference for using wingsets on patients with fragile or difficult-to-access veins. This preference is often reinforced through conversations with clinicians around the country.

Their preference and ultimate decision to use wingsets is based on what they believe is best for the patient, which is how every institution should approach the issue and how the debate should play out in the broader marketplace. Unfortunately, the decision to restrict clinician and patient access to wingsets often rests in the hands of people far-removed from laboratories and hospital floors. Rationing wingsets in favor of less expensive straight needles may provide short-term savings to capture on a spreadsheet.  However, it could backfire significantly, especially in a reformed Medicare payment system that bases reimbursement levels on patient satisfaction survey scores.

Restricting access to the blood collection device that clinicians value and patients prefer might prove to be a costly mistake. It only takes one bad stick to get things off to a rocky start and one bruise to serve as a reminder of the unpleasant experience—an experience that may stay with patients as they fill out a patient satisfaction survey or describe the experience in vivid detail to friends and relatives via a social media smartphone app.

Ana Stankovic, MD, PhD, MSPH, is Vice President, Medical Affairs, for Becton, Dickinson, and Company, provider of the BD Vacutainer® Push Button Blood Collection Set and the BD Vacutainer® Eclipse™ Blood Collection Needle.  Dr. Stankovic is also Associate Clinical Professor at Vanderbilt University.


  1. The Lewin Group. The value of diagnostics: innovation, adoption, and diffusion into health care. Advanced Medical Technology Association, 2005.
  2. American Opinion Research. Patient preferences for blood collection devices. July 2012.
  3. American Opinion Research, Clinician preferences for blood collection devices. June 2012.
  4. Hotaling M. Efficacy of a retractable safety winged steel needle (butterfly needle performance improvement project). The Joint Commission Journal on Quality and Patient Safety. 35:2.
  5. Rupp ME, Jourdan D, O’Neill J, Tyner K, Marion N, Stoner J. Effect of a safety-engineered phlebotomy device on activation compliance and sharps injury. University of Nebraska Medical Center and Nebraska Medical Center, Omaha, NE. 2007.
  6. BD White Paper: A comparative study of the BD Vacutainer(R) Eclipse (TM) Blood Collection Needle and the BD Vacutainer (R) Push Button Blood Collection Set for Sample Quality, VS9100, December 2012.