Smashing the innovation hierarchy in healthcare: Innovating around blood draws in our kids

An Opportunity to Move the Dial on Patient Satisfaction in a Common Procedure

Pediatric medicine is more often than not a "calling" --- the result of a personal commitment to reduce suffering in our children. This mission-oriented sense of purpose exists at odds with the economic realities of the industry. Pediatric hospital units are at a disadvantage when it comes to realizing innovation because the marketplace for adult services and devices is economically far more enticing for the larger, more established companies driving the types of innovation that most aligns with shareholder value. Investment dollars, human capital, and ideas are first funneled into the larger adult market, and - if at all - will eventually make their way into children as an afterthought.

This innovation hierarchy in healthcare brings limited advances in pediatric medicine in part due to an unattractively small market size, limited investment returns, and a lack of public incentive programs. However, in the face of these skewed incentives, the field of pediatric medicine may have a rare opportunity to reverse this pyramid by driving advances in blood collection technologies and standards. By innovating for our kids first, we may ultimately solve for an unmet need across wider adult populations.

Every year, more than 400 million blood draws are performed in U.S. hospitals. But the way in which we collect blood has not materially changed in nearly 100 years. We continue to use a sharp object for a puncture, tearing through our kids' veins to collect lab samples; an event that creates anxiety and suffering for patients and stress for caregivers. Stories abound of pediatric patients that began to cry at the mere sound of the phlebotomy cart in the hall, regardless of whether the blood draw is meant for them.

With routine venipuncture representing one of the most common sources of pain and fear in hospitalized children, blood draws could actually be an immense opportunity to reverse the innovation hierarchy. Nearly one out of every two of these venipunctures fail, requiring a second or even third stick. One young child could have been in and out of the hospital since birth with thousands of blood draws that have left him traumatized – his heels too sensitive to let anyone touch his feet, his now fragile veins requiring so many sticks for a blood draw that he tallies the poke marks after every collection, and he often needs 30-minutes or more after every attempt to calm down so they can try again.

As a result of this type of trauma and repeat needle sticks, it's no wonder more than 50% of children experience high levels of stress before, during and after. This difficult situation plays out across the US approximately 20 million times annually. A parent's implicit expectation for first stick success can shape their perception of skill and is interpreted as a reflection of quality of care. These procedures are also costly for hospitals, requiring extensive staff time, products, and higher cost vascular access interventions. Our youngest, most vulnerable patients are going through formative stages of physical and emotional development, and a large majority present with fragile veins. Current blood collection devices aren't designed for a child's unique venous system, creating a potentially greater risk for complication and injury.

This is occurring at a time when patient satisfaction is an increasingly core concern of hospitals and survey scores ultimately determine government reimbursement dollars for patient services. As a result, hospitals are investing millions of dollars in facility and environmental upgrades in an effort to raise these scores. It would seem that easing patient fears is an equally (and possibly less expensive) way to positively impact these same scores. If a basic procedure like blood collection inflicts so much pain and fear in adults and children alike, why wouldn't we challenge the norm of one of the most common, overlooked practices in healthcare to move the dial on patient and caregiver satisfaction?

The opportunity to innovate around in-patient blood collection, and specifically pediatric collections, then is one framed by both emotional and financial benefits. It has the potential to upend the innovation hierarchy for all the right reasons.

First, it aligns with an industry-wide emphasis on patient centered care and patient experience. Pediatric care is inherently delivered through the lens of the "experience" with caregivers using extraordinary measures to eliminate pain, discomfort and fear in our children and their parents. A more compassionate standard of care for blood draws that eliminates the sticking and re-sticking of children can turn a frequent and traumatic experience into a routine - even unnoticed - one.

Second, it presents a rare opportunity to innovate initially in pediatrics. By addressing the unmet needs of the smallest patients, we may uncover blood collection solutions with application for all of us, and thereby trace a financial path from minimal economic risk to maximum application. And because blood draws are such a huge practice area with long established norms, it could even be easier to first turn the ship in a smaller – and more motivated – subset of patients that will eventually build momentum for wider industry change.

Our mission at the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System is to make pediatric surgery more precise, less invasive, and pain free. We provide various incentives in form of grant opportunities and consultation services to device developers that demonstrate solutions to address unmet pediatric needs. In 2014, we saw for the first time a novel needle-free blood draw device from Velano Vascular that utilized existing peripheral IV access for hospitalized children. It was one of the winners of our Annual Pediatric Innovation Symposium that year, but more importantly, it opened our eyes to the opportunity for change in pediatric blood draw.

We recognize that device development is a highly iterative process. In addition, there are special ethical considerations when conducting research in the pediatric population. Our physicians and nurses have welcomed the opportunity of working with device innovators and others to find safer and painless ways to collect blood from the children we treat. And in the process, we are invigorated by the challenge to use pediatric innovations to realize industry-wide change and disrupt the traditional innovation hierarchy.

Kolaleh Eskandanian is the executive director of the Sheikh Zayed Institute for Pediatric Surgical Innovation at Children's National Health System and the FDA-funded National Capital Consortium for Pediatric Device Innovation, focused on accelerating the path to market for pediatric devices. Kolaleh works with a large network of small and large businesses, nonprofits, and government agencies---all to promote a cause close to her heart, addressing the unmet medical needs of children. She is the producer of two annual innovation competitions that select small businesses who demonstrate the ability to address a significant medical need in the pediatric space. Since early 2014, a total of 40 pediatric medical device companies have been funded through these competitions.

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