News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

For Medical Laboratory Tests, PIVO Enables Healthcare Practitioners to Obtain Blood Samples from Hospital Patients without a Needle Stick

Because patient satisfaction continues to drive Medicare scoring, interest grows in technologies that reduce or remove pain from the patient’s experience, particularly when a phlebotomist draws blood for clinical laboratory testing

Clinical laboratories know full well that patients do not like being stuck by needles. And hospital administrators know that increasing the hospital’s patient-satisfaction scores is important for Medicare hospital accreditation.

This is why hospital administrators are devoting more attention—and budget dollars—to products that have the potential to reduce the pain experienced by patients. And patient satisfaction surveys regularly identify pain during phlebotomy procedures as an issue.

Enter PIVO, a sterile single-use device created by San Francisco-based Velano Vascular Technologies that attaches to an existing peripheral intravenous (PIV) line to extract blood samples from patients through the use of a vacuum tube or syringe, relieving the pain of additional needle sticks.

Needle-free blood draws is not a new concept. But the fact that hospitals are adopting such technologies indicates that the need to improve the patient experience is motivating more hospitals to spend money on these types of devices.

Velano Vascular’s PIVO device (above) works by pushing a small, flexible flow tube through the IV line and directly into the vein to collect as much blood as needed for medical laboratory testing. After the blood collection has been completed, PIVO is retracted and removed from the IV and discarded. As public demand for pain free healthcare increases, will the practice of phlebotomy in all healthcare settings need to adopt as well? (Photo copyright: HIT Consultant.)

Nurses Approve of No-Stick Technology

The Centura Health system in Centennial, Colo., utilizes PIVO at all 17 of its hospitals throughout Colorado and western Kansas. Centura’s goal is to “eliminate some of the suffering that goes along with needlesticks for inpatients,” Rhonda Ward, MSN, Vice President Nursing Services and Chief Nursing Officer, South Denver Group, Centura Health, told Modern Healthcare.

“It adds no pain to the patient,” she said. “Unfortunately, nurses, just by nature of their work, have to create discomfort in some of the things that they have to do. So not creating more pain for the patient has been a big satisfier.”

Velano Vascular first gained FDA marketing clearance for its proprietary intravenous blood-draw device in 2015. Later that same year, Intermountain Healthcare in Salt Lake City became the first healthcare system in the country to implement the PIVO device. Intermountain now uses PIVO in all 22 of its hospitals.

“Blood draws are critical, common elements in modern medicine, but they cause an unnecessary amount of anxiety, pain and risk due to the use of century-old technology and practice,” said Kim Henrichsen, MSN, Senior Vice President, Clinical Operations/Chief Nursing Executive, Intermountain Healthcare, in a press release. “We are thrilled to offer a new standard of care that, over time, will help obviate the need for needles used for hospital blood collection. This commitment to standardizing draws will enhance quality for both patients and practitioners.” 

According to the Velano website, there are 400 million inpatient blood draws in the US each year, with each patient receiving 10 to 20 needlesticks per hospital stay. The site also states there are more than 1,000 practitioner needlestick injuries per day in the US and that approximately one in five people in the country are needle phobic. The company claims the advantages of the PIVO device include reducing patient pain and anxiety, making blood draws easier for Difficult Venous Access (DVA) patients, and making the blood extraction process safer for practitioners.  

“It is baffling that in an era of smartphones and space travel, clinicians draw blood by penetrating a vein with a needle—oftentimes in the early morning hours,” said Todd Dunn, Director of Innovation at Intermountain Healthcare Transformation Lab in the Intermountain press release. “Through our Design for People program, we resolved to find a better way for our phlebotomists and nurses to more humanely and consistently draw blood. Following 15,000 PIVO draws on adults and children with no adverse events and overwhelmingly positive feedback from patients and caregivers alike, it is clear that we are together establishing a new standard of care.”

According to a survey commission by Velano Vascular and conducted by Charter Oak Research of more than 6,500 nurses from 24 hospitals regarding the blood collection process:

  • Eight out of ten nurses are concerned about needle safety.
  • One in three patients are considered tough sticks.
  • 88% of the nurses felt that blood collection sticks and re-sticks negatively impact the patient experience.
  • 76% of the nurses would prefer to use needle-free blood draws over venipuncture.
  • 84% of the nurses said they would advocate for a needle-free blood draw device.

One of the key findings in the survey found that there is a lack of standardization in blood collection, and that there is “significant variability in who and how blood is collected across patient floors and time of day.”

“Commercial demand for PIVO and our family of novel solutions is being driven by a move to one-stick hospitalization and a growing realization that removing needles from blood draws improves the patient experience, protects practitioners, and boosts the bottom line,” Eric Stone, Chief Executive Officer and co-founder, Velano Vascular, told FierceBiotech.

More Research versus Patient Outcomes

Though there are peer-reviewed studies and white papers outlining positive patient outcomes surrounding the use of the PIVO device, some professionals feel more research on the product is needed.

“All of these studies would suggest that additional study would be warranted,” Diane Robertson, Director Health Technology Assessment and ECRIgene Information Services at the ECRI Institute, told Modern Healthcare. “But while the evidence is inconclusive at this point on a number of the potential benefits, in studies and in our look at safety information, there’s been no indication that there’s been any harm from this technology. It’s reasonable for hospitals to consider it. It goes back to weighing the patient-oriented outcomes.”

The need to improve the patient experience and improve patient satisfaction scores is motivating hospital administrators to spend money and resources on products like the PIVO device. Clinical laboratory leaders should be aware of the rate of adoption of such products by healthcare systems.

Continued growth in products that can collect medical laboratory specimens without a traditional venipuncture performed by a phlebotomist could give innovative labs a new way to add value in patient care in both inpatient and outpatient settings.

—JP Schlingman

Related Information:

Centura Health Cuts 30,000 Needles with New Blood-draw Program

What Do Nurses Think About Blood Collection?

A Novel Needle-Free Blood Draw Device for Sample Collection from Short Peripheral Catheters

Centura Health Joins Innovative Movement for One-Stick Hospitalization

Intermountain Healthcare First System in Nation to Remove the Needle from Blood Draws

Velano Taps $25M in New Funding for its Needle-free, Bedside Blood Draw System

University Hospitals Adopts Needle-Free Blood Draw Technology

Will Growth in Number of Tele-ICU Programs in the Nation’s Hospitals Create an Opportunity for Clinical Pathologists to Deliver Added Value?

Aging populations and increase in chronic disease fuel worldwide growth in tele-ICU care models that improve patient outcomes, reduce length of ICU stays, and save hospitals money, according to a study

There’s an interesting trend in healthcare that may prove beneficial to clinical pathologists and medical laboratory scientists. It is increased use by hospitals of remotely-monitored intensive care units (ICUs), which creates the opportunity for clinical laboratory specialists to remotely collaborate with their colleagues in real time.

This new approach in how hospitals alter how they monitor their patients’ care and organize their intensive care units is dubbed Tele-ICU. The technology uses “an off-site command center in which a critical care team [made up of intensivists and critical care nurses] is connected with patients in distant ICUs to exchange health information through real-time audio, visual, and electronic means,” according to a study published by AHIMA (American Health Information Management Association) that sought to identify the “possible barriers to broader adoption.”

This approach to emergency care from a distance employs telemedicine technology and has the potential to impact how in-house medical laboratories provide clinical testing services to hospital physicians.

Tele-ICU Gaining Foothold in Healthcare

Tele-ICUs are making speedy inroads into hospitals and healthcare systems. According to a statistic provided to Healthcare Dive by Advanced ICU Care, a provider of remote ICU monitoring services, an estimated 15% to 20% of hospitals currently use tele-ICU programs.

The use of this “second set of eyes” in ICUs is expected to grow. It is encouraged by an increasing number of studies showing:

  • Improved patient outcomes;
  • Reduced length of ICU stays; and
  • Cost savings.

A Global Market Insights report predicts the tele-ICU market will reach $5 billion in 2023. That’s more than four times 2015’s $1.2 billion level. The rise, the report states, will be fueled by an increase in aging populations and chronic conditions such as cancer, neurological disorders, and other chronic diseases.

The graphic above illustrates the wide range of telehealth services available to hospitals for remote critical and in-home ambulatory care. To remain competitive, medical laboratories not yet engaged in providing testing services to remote care programs will need to adopt the technology. (Image copyright: Philips.)

Intermountain Healthcare’s TeleCritical Care program has paid dividends for the not-for-profit health system. Since 2014, Intermountain has introduced tele-ICUs in 12 of its 22 hospitals that have ICUs, and in five non-system hospitals. A pilot project has expanded the program to two rural critical access hospitals that do not have ICUs. Five more rural hospitals are also expected to join Intermountain Healthcare’s tele-ICU program.

“There’s a tremendous amount we can do from this location without being literally present,” William Beninati, MD, Medical Director for TeleCritical Care at Intermountain Healthcare, stated in a Healthcare Dive article.

Intermountain Healthcare’s analysis of 6,500 of its patients indicates tele-ICU implementation has enabled its community hospitals to treat patients with more complex cases and reduce mortality by 33%. An initial cost analysis was equally favorable, with a $4.4 million decrease in the cost of care provided and a $3.3 million decrease in reimbursement amounts.

“We’re seeing a rapid return on investment on a roughly one-year timeframe,” Beninati told Healthcare Dive.

Helping Hospitals Thrive in Value-based Environments

A study published in CHEST Journal in February 2017 by UMass Memorial Medical Center supports the argument for tele-ICU’s financial benefits. According to a Philips press release announcing the UMass Memorial study results, the researchers found the Philips telehealth eICU Program with centralized bed management control increased case volume by up to 44% and improved contribution margins by up to 665%, or $52.7 million.

Philips’ eICU telehealth technology

Philips’ eICU telehealth technology (above) combines A/V technology, predictive analytics, data visualization, and advanced reporting capabilities to deliver critical information to caregivers at remote locations. (Photo copyright: Philips.)

Other investigations have recognized the value intensivist-centric models can play in improved patient outcomes, such as this 2014 HIMSS study, which compared ICU length-of-stay findings among three primary studies of tele-ICU use that were published from 2009 to 2014. The analysis found tele-ICU programs improved patient outcomes, particularly length of stays (from 6.9 days pre-intervention to 4.2 days post-intervention). And there was “strong evidence” that secondary outcomes such as ICU mortality and hospital mortality also decreased as a result of tele-ICU use.

“An ICU bed costs approximately $2 million to build, and this study demonstrates a significant increase in case volume by better utilizing existing resources,” said Tom Zajac, Chief Executive Officer and Business Leader, Population Health Management, Philips, in the Philips press release. “This shift enables care for expanding populations without having to build and staff additional ICU beds, thus helping hospitals thrive in a value-based care environment.”

Alignment of Attitudes Key to Tele-ICU Success

In a Healthcare Dive articleLou Silverman, CEO of Advanced ICU Care, a provider of tele-ICU services, said the role of a tele-ICU differs based on a hospital’s staffing.

“If intensivists are internally staffed by the hospital, tele-ICU provides a second set of eyes—an additional layer of patient safety in partnership with the bedside team,” Silverman noted. “When intensivists are not readily present, tele-intensivists take a more active role directing patient care, including intervening in urgent situations.”

However, the physician who led the UMass study argues that successful tele-ICU programs requires an alignment of attitudes as well as technology. Craig M. Lilly, MD, Director of the eICU program at UMass Memorial Medical Center, says healthcare providers at the bedside, and those overseeing the ICU from a distance, must communicate well and collaborate on both ends of the telemedicine platform.

“If you apply the technology the way it was designed [to be applied], it can make a difference,” Lilly told mHealthIntelligence. “But if you don’t have collaboration, it’s not going to work. Then you have … relative antagonism.”

As Dark Daily has previously noted, anatomic pathology laboratories were among the first to adopt remote telemedicine models though the use of whole-slide imaging and digital pathology services. As tele-ICU becomes more prevalent, medical laboratories will have the opportunity to use their access to real-time patient lab test data to help the clinicians in tele-ICU centers better manage patient care. This would also be an opportunity for pro-active clinical pathologists to step up with consultative services that contribute to improving patient outcomes.

—Andrea Downing Peck


Related Information:

How Tele-ICUs are Giving Hospitals a Boost

Reducing ICU Length of Stay: The Effect of Tele-ICU Market Size

Tele-Intensive Care

ICU Telemedicine Program Financial Outcomes

Telemedicine Success Requires an Alignment of Incentives (and Attitudes)

New Study Demonstrates Improved Patient Flow and Financial Benefits of Philips eICU Program for Managing Critical Care Populations

Study: Tele-ICU Programs Improve Care While Providing Cost Savings

Survey Reveals US Consumers Choosing PCPs Based on Access to Telehealth Services; Clinical Laboratories Can Capitalize on This Trend

From Micro-hospitals to Mobile ERs: New Models of Healthcare Create Challenges and Opportunities for Pathologists and Medical Laboratories

Wal-Mart Developing Telemedicine Clinics in Selected Stores

Growing Cost of Telemedicine, Telepathology, and Medical Data Transmissions Is a Budget-Buster in Oklahoma

International Telemedicine Gains Momentum, Opening New Markets for Pathologists and Other Specialists

Attention Blood Bankers and Pathologists! New Cloud-Based Technology Platform Provides Hospitals with Real-Time, On-Demand Access to Blood Products at the Best Prices

To match the supply of blood products to demand, a clever entrepreneur has created an award-winning business that may help clinical laboratories better manage the cost of blood products in their hospitals and health systems

There’s something new and exciting in the world of blood banking and medical laboratory medicine. It’s a unique approach to matching the availability of blood products to the demand for those same products and it’s catching the attention of medical laboratory directors and blood bankers in many of the nation’s hospitals.

How did an ice storm and a Super Bowl factor into the development of an innovative and disruptive technology that addresses a persistent gap in the US blood products supply chain? In February 2011, central Texas was hit by fierce weather that not only disrupted flights, snarled traffic, and threatened Super Bowl XLV, it also impacted the local and regional hospitals’ ability to access blood for patients in need. Enter a young entrepreneur who saw a critical problem and understood that the raw materials for a solution already existed. (more…)

For Embattled Medical Laboratory Company Theranos, Bad News Keeps on Coming After Two Federal Inspections Show Problems in Certain Lab Practices

High rates of variability from one drop to another raise questions about the reliability of point of care testing equipment and companies that collect lab specimens only with finger sticks

Since last fall, one news report after another has come out with bad news for Theranos Inc., the high-profile medical laboratory company. The reports have ranged from dissatisfaction among Theranos’ partners, such as Walgreens and Capital BlueCross, to failed inspection reports from the federal Centers for Medicare and Medicaid Services (CMS) and the U.S. Food and Drug Administration (FDA).

In response, the embattled lab company in Palo Alto, Calif., has maintained that it is doing everything it can to correct any deficiencies in its clinical laboratory testing methods and to ensure its partners that its processes are scientifically sound and its methods valid. (more…)

Many Hospitals and Doctors Not Happy with Federal Rules for Accountable Care Organizations (ACOs)

Major healthcare stakeholders speaking out with criticisms of federal ACO rules

It may be that the Obama administration bit off more than it can chew with its first release of proposed rules for Accountable Care Organizations (ACO). Lining up in opposition to these rules is an impressive list of the nation’s most respected healthcare organizations. Included are Mayo Clinic, Geisinger Health System, Cleveland Clinic, and Intermountain Healthcare.

Pathologists and clinical laboratory managers will undoubtedly recognize the significance of this opposition. Health officials within the Obama administration have regularly stated that ACOs should be organized to deliver the same type of tightly integrated healthcare that is the standard at Mayo Clinic, Geisinger Health, Cleveland Clinic, and Intermountain Health. Thus, it is not auspicious for the Obama administration that these four institutions are making public statements that, under the ACO rules as now written, they are not inclined to participate.