pediatrics: improving the patient experience in the UK

In Europe, some pediatric programs are taking a new, minimally invasive approach to specimen collection. Their efforts are improving things for children, especially those who must undergo frequent testing for medical conditions.

Children do not experience pain in quite the same way that adults do. They have an intense emotional reaction to most unpleasant sensory input. They don't like it, and they are very much afraid of it. Since they do not understand why they should go through a painful experience, they fight it. They kick. They scream. The episode is nerve wracking and upsetting for everyone.

Making Pediatrics a Low-Stress Experience

Drawing blood is an example of the kind of painful experience that makes kids run for the door as soon as they see the white coats. But it doesn't have to be that way. Traditionally, blood samples needed for laboratory testing are drawn from a vein, which typically requires a poke in the arm. A long needle is used to draw the blood, once the vein is located. Locating the vein means probing around in the arm with the needle. Because of their subcutaneous fat, veins in children are difficult to find. Sometimes multiple sticks are required, which is very traumatic for the child — and anyone else in the room.

Pediatric Program in the UK Sets a Good Example

In the United Kingdom, a special program for pediatric organ transplant patients is taking advantage of new technology on the market designed for less invasive, remote specimen collection. The new technology allows for microsampling, which is as minimally invasive as it sounds. Instead of 10 or 20 ml of blood being drawn from a vein in the arm, two small drops of blood (10 µl) are collected from a fingertip after a nearly painless finger-stick with a tiny lancet. These smaller samples are called "microsamples."

Here are some of the advantages of microsampling over conventional venipuncture, as reported by pediatric clinicians in the UK who have adopted this new technology:

• The microsampling procedure is markedly less painful and frightening than venipuncture, particularly for sensitive populations — children and the elderly
• Less blood is drawn, decreasing the chances of anemia developing in children due to high-volume blood draws.
• Microsampling does not require the skills that a laboratory technician or phlebotomist must have to be successful at venipuncture.
• There are fewer steps in processing the blood. The entire process is easier, and therefore, cheaper.
• Because children tolerate a finger-stick much better than they tolerate a blood draw with venipuncture in the arm, parents do not feel guilty about the blood collection as a "necessary evil."
• UK practitioners report better patient compliance after introducing microsampling, particularly if they offer it as a home service that the parents can perform, because parents are much more likely to continue providing microsamples when needed.

In the UK, Microsampling is being used on an at-home basis for remote testing and monitoring of blood levels for drugs such as antibiotics, anti-seizure medications, antidepressants, and psychiatric medications. Microsamples deliver accurate results that help care teams determine whether a patient's drug levels are therapeutic, and also help to guard against toxicity and related side effects.

A child's experience as a patient doesn't need to be so traumatic that it becomes a negative memory that impacts future healthcare experiences. Let's follow the example set by early adopters of microsampling in the UK, and try to improve those early healthcare experiences by taking some of the pain and fear out of specimen collection for lab testing.