Some pediatric blood draws fail before testing even begins. These encounters go unmeasured, unnamed and are consequential
Some pediatric blood draws fail before testing even begins. These encounters go unmeasured, unnamed and are consequential
In pediatric laboratory workflows, some encounters end before a usable specimen is obtained. When this happens, the encounter may disappear from traditional laboratory quality measurement.
Most laboratory dashboards track specimens received. Few track encounters where no specimen is obtained.
Examples include:
• no specimen obtained
• abandoned or escalated collection attempts
• workflow friction during pediatric encounters
• missed opportunities for improvement
Access Before Analysis™ was created to make these moments visible in a structured and measurable way.
Access Before Analysis™ is an observational framework that documents specimen acquisition feasibility before laboratory analysis begins.
This is especially visible in pediatric and high-variability populations, where distress, resistance, or workflow breakdown can prevent successful specimen collection.
It focuses on the pre-analytic stage — the real-world conditions that affect whether specimen collection can occur reliably enough for analysis, workflow evaluation, and improvement planning.
The framework helps organizations:
• identify where access variability occurs
• document workflow barriers
• create a foundation for improvement efforts
• support safer pilot planning
Where this shows up:
Why this matters:
Access Before Analysis — Framework Rationale Page
When a child cannot tolerate a blood draw, they cannot access the diagnostic information their physician needs to care for them.
The physician can't act on information they never receive. The parent can't advocate for results they never obtain. The child can't communicate what they can't yet express. And somewhere in the middle — a blood draw that never happened.
That failure is invisible to every quality metric currently in use. It is not counted. It is not investigated. It disappears. The laboratory order exists. The clinical question exists. But the answer never enters the system — because the encounter that would have produced it fell apart before the needle went in.
This is an access issue hiding inside a clinical procedure that happens millions of times a year.
Adults see medical encounters in silos. Dentist. PCP. ENT. Laboratory. MRI. Each one separate. Children see them in ONE silo. Trust transfers. So does trauma. A child who experiences a traumatic blood draw doesn't leave that experience in the lab. They carry it into every subsequent medical encounter — compounding avoidance, eroding trust, and creating barriers to care that follow them for years.
For neurodivergent children — those who are nonverbal, sensory-sensitive, or without the language to express what they need — the consequences are compounded further. Their behavioral responses to fear, pain, and sensory overwhelm are too often misread as non-compliance rather than communication. Their distress is absorbed and normalized rather than recognized as a signal that the approach itself is wrong.
The result is a diagnostic blind spot with measurable clinical consequences. Tests expected to guide diagnosis and management never yield a result. Physicians encounter the problem as missing data rather than a documented access event. The child goes without answers that a different approach might have made possible.
Access Before Analysis™ exists to make these encounters visible for the first time — to count what has never been counted, name what has never been named, and build the evidence base for a standard of care that every child deserves.
The children have waited long enough.
Access Before Analysis™:
• does not compare devices
• does not validate analytes
• does not make performance claims
• does not replace clinical judgment
It is an observational framework designed to characterize pre-analytic access variability before downstream evaluation begins.
Understand where specimen collection workflows break down and where improvement efforts should begin.
Capture pre-analytic variability that traditional metrics may miss.
Understand workflow feasibility without analytic claims.
Looking for pediatric preparation and training resources? Visit Poke Pals™ at www.pokepalskids.com
An exploratory Access Before Analysis™ pilot may include:
• structured observational access mapping
• workflow review of defined pediatric encounters
• identification of escalation points and barriers
• summary outputs to inform improvement planning
Access Before Analysis™ was created by Franchesca Kelly, ASCP-certified pediatric phlebotomist (PBT), Medical Laboratory Assistant (MLA, AMT), and Registered Behavior Technician (RBT) with published work in Contemporary Pediatrics, CLP, and ASCP Critical Values.
https://clpmag.com/diagnostic-technologies/pediatric-testing-problems-labs-arent-measuring/
Access Before Analysis™ is a trademarked observational framework in active research development. Franchesca Kelly franchesca@accessbeforeanalysis.com
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