You can’t analyze what you can’t access.
By Franchesca Kelly, PBT(ASCP), MLA, RBT
Physicians and parents rely on laboratory testing to guide critical decisions about a child’s care. Bloodwork supports diagnosis, informs treatment plans, and enables ongoing monitoring. In practice. However, the ability to obtain a specimen is not always straightforward, particularly in pediatric settings.
For many children, especially those with sensory sensitivities, anxiety, or developmental differences such as autism or ADHD, blood collection can be an overwhelming experience. A procedure that appears routine from a clinical perspective can quickly become distressing for the child and challenging for caregivers and clinical staff to manage.
When this occurs, the clinical process slows or stops entirely. In my practice, I have seen this unfold in real time, often in otherwise routine encounters: a child who initially agrees to a blood draw, sitting close to a parent for reassurance but becomes overwhelmed as the procedure progresses and the sensory experience intensifies—the smell of alcohol, the feel of the tourniquet, the sight of needles and collection vials. Their arm pulls back and stiffens. Their breathing quickens. And a calm moment shifts into distress, leaving the child and parent unsettled and the phlebotomist navigating a situation that has quickly become unpredictable.
The procedure is paused, then abandoned. No specimen is collected. No result is generated, and the encounter is often documented simply as “unable to obtain” or “redraw.” From a systems perspective, it disappears. From a care perspective, it delays answers and can erode trust in future visits. The test is not completed, the necessary data is not collected, and care decisions are delayed. In some cases, families leave without a clear next step or hesitate to return for follow-up care.
Despite how frequently these situations occur, most healthcare systems do not capture them in a meaningful way.
Where Existing Quality Frameworks Fall Short
Modern laboratory medicine has made significant progress in standardizing and improving what happens after a specimen is collected. Organizations such as the College of American Pathologists and the Clinical and Laboratory Standards Institute have established widely adopted pre-analytic quality indicators, including hemolysis rates, labeling accuracy, specimen integrity, and transport conditions.
These measures have strengthened laboratory performance and consistency. At the same time, they depend on a shared assumption that a specimen is successfully obtained.
In pediatric care, this assumption creates a gap. When clinicians attempt a blood draw but do not complete it, the event often goes unrecorded. No specimen enters the system, so no quality metric is triggered. From a data perspective, the encounter does not exist, even though it directly affects patient care.
The Missing Metric: Access
If a child cannot tolerate the conditions required for a blood draw, the diagnostic process fails before it begins. This outcome reflects a limitation in care delivery rather than a limitation in laboratory science.
I refer to this as “access before analysis,” a pre-analytic consideration that ensures specimen feasibility is established before performance is evaluated. Healthcare systems must first ensure that patients can successfully provide a specimen before they evaluate its quality. Achieving this requires attention to factors that traditional laboratory frameworks do not fully address, including the sensory environment, the way clinicians prepare patients and families, the communication strategies used during the procedure, and the flexibility of collection methods.
Without addressing these elements, even the most advanced diagnostic capabilities remain underutilized.
Innovation Is Expanding What Is Possible
Healthcare leaders have begun to recognize the need to improve how specimens are collected. Advances in microsampling and patient-centric blood collection technologies have expanded the range of options available to clinicians. These approaches enable less invasive collection and allow patients to provide samples in more comfortable settings, including at home.
Microsampling and patient-centric collection methods typically rely on small-volume, capillary blood samples rather than traditional venous draws. Many of these approaches are designed to be low- or no-pain, avoid the need for a needle in a vein, and eliminate visible sharps, which can be a major source of anxiety for children. In some cases, samples can be collected quickly and in non-clinical settings, giving families more flexibility in how and where testing takes place.
At their core, patient-centric blood collection methods are designed to meet patients where they are, both physically and emotionally. Instead of requiring every patient to navigate a potentially stressful clinical environment, these approaches offer alternatives that better align with individual needs and preferences. For children and their families, this can mean reducing the sensory and psychological burden associated with traditional blood draws, while still enabling clinicians to obtain the information they need.
The need for this flexibility is clear. Research shows that many patients face meaningful barriers to routine blood testing, with 69% reporting they are unwilling to travel more than 10 miles for a blood draw and 78% experiencing anxiety related to the procedure. These challenges can be amplified in pediatric populations, where fear, discomfort, and unfamiliar environments can make successful collection even more difficult.
By reducing pain, simplifying the collection process, and allowing for greater flexibility in where and how samples are obtained, patient-centric technologies expand access to care. They give clinicians more options to successfully collect specimens and help ensure that necessary testing can move forward without adding unnecessary strain on patients and families.
Bridging the Gap Requires Preparation and Training
Technology alone cannot resolve the challenges associated with pediatric blood collection. Success depends on how clinicians and caregivers prepare children for the experience and how they respond in the moment.
Training plays an important role in improving outcomes. When healthcare professionals and parents understand how to reduce fear, communicate clearly, and create a more predictable experience, children are more likely to tolerate the procedure. Preparation strategies can include setting expectations in advance, using developmentally appropriate language, and adjusting workflows to accommodate individual needs.
These approaches recognize that successful specimen collection depends on both technical capability and human interaction.
Making Access Visible
Healthcare systems cannot improve what they do not measure. In pediatric care, this includes encounters where specimen collection is attempted but not completed. This includes tracking unsuccessful collection attempts, repeat visits required to obtain a specimen, and the resources needed to complete a single draw. Systems should also consider how often difficult experiences lead families to disengage from care.
These data points provide a more complete picture of quality because they capture whether patients can access the diagnostic process, not just how well laboratories handle specimens once they receive them.
A More Complete Definition of Quality
Laboratory medicine has long focused on ensuring that every specimen meets high standards of accuracy and reliability. The next step is to ensure that every patient has a fair opportunity to provide one.
For pediatric populations, this requires addressing both the clinical and experiential factors that influence whether specimen collection succeeds. Until healthcare systems incorporate access into their definition of quality, a portion of pediatric diagnostic care will remain out of reach. The limitation does not stem from a lack of available tests, but from gaps in the process required to obtain them.
Because ultimately, no matter how advanced our diagnostics become, clinicians cannot analyze what they cannot access.
About the Author: Franchesca Kelly, PBT(ASCP), MLA, RBT, is a pediatric phlebotomy specialist and the founder of Access Before Analysis and Poke Pals. With over nine years of experience in pediatric blood collection, she focuses on improving pre-analytic access, patient experience, and workflow readiness in high-variability clinical environments.
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