I-11: Optimizing the ART Outcome

Background: The establishment of a high quality ART program requires a multi-disciplinary effort, involvement and commitment of all staff members – team work. It is of vital importance that all aspects of the treatments are taken into consideration and that you already from the start use high international standards to initiate a wellorganised ART program that meets the requirements from patients and staff. In my talk I will try to cover both the staff and the patient’s perspectives of an optimal treatment – from construction, equipment, disposables, Total Quality Management (TQM) and treatment procedures. The location for the clinic should be selected carefully, since high traffic areas and polluted air has a negative outcome of the treatment. As a proactive preventive measure the clinics HVAC system is fitted with HEPA and charcoal filters (Me, VOCs) and that building materials and furniture that do not contain or release toxic compounds into the laboratory environment.A logistic layout of the clinic and location of equipments reduces the time spent to perform the procedures and is thereby more efficient, thus saving money for the clinic. All essential equipments are plugged into sockets connected to an uninterrupted electrical power supply (UPS), which eliminates effects of power failure on ongoing treatments. Incubators are supplied with an uninterrupted inflow of medical grade CO2. After proper installation the equipments are calibrated with certified testing equipments and their performance continuously followed and documented.After selection and installation of equipment and purchasing of embryo-tested disposables (evidence-based medicine) the premises are thoroughly cleaned and evaluated. In order to obtain and maintain an optimal level of patient care and success rates, a Total Quality Management (TQM) system (covers all aspects of the clinic and the procedures, from facility parameters, initial evaluation of a patient, stimulation protocols, culture and embryo transfer techniques, gestational period, to parameters in connection with the delivery of the baby) must be implemented. Implementation of a TQM system is associated with a huge workload and requires investments. However, due to increased standardization and efficiency of all processes and procedures, improved transparency and traceability of all actions performed, the quality of service improves substantially, which is of benefit for both the customer and the staff. TQM is not only designed to detect and eliminate problems, but also to constantly improve the clinic’s performance by incorporate latest know-how and techniques, as well as to make all procedures and processes more effective and reproducible.It is essential that all staff members knows exactly how, why and when everything is to be performed, which standardizes the routines and optimizes the outcome of the patient’s treatment cycle. Standardization is obtained by the introduction of standard operational procedures (SOPs) that can be of technical (equipments) or clinical type. The SOPs are upgraded yearly and the latest international technologies and bench mark processes and procedures are incorporated in a never-ending project. Indicators are an important tool for auditing of the clinic’s performance over time, for detection of gradually declining results, performance of individual staff members and areas of need for education. The indicators should be internationally defined and recognised, which reduces misinterpretations and facilitates internal as well as international communication and auditing. Unfortunately, many clinics only focus on the ultimate outcome – pregnancy rates, which do not assess the overall quality of the ART program.The laboratory is run by an experienced embryologist, who interacts with representatives for the clinicians and nursing, for the creation of an optimal treatment tailored to the expectations and medical background of the couple. The management of staff is highly neglected and it is therefore very important to develop a staff friendly environment, where highly trained, motivated and skilled staff members with high self-esteem develops, thrives and are retained. Do not underestimate the effect that a staff-friendly environment has on the outcome of the treatments.Despite that TQM of an ART clinic is a never-ending effort, costly, time-consuming and a lengthy process, the many positive outcomes that this leads to is highly beneficial for the clinic, staff and especially the patients. There is no doubt that a standardization of the many processes within the clinic facilitates the communication between staff, patients and other clinics. Remember that there are no short-cuts to perform a work of excellence and that all staff categories must be involved and committed. A couple that undertakes a treatment in a “controlled” environment will be given an optimal and safe treatment in a safe environment by highly educated, skilled and professional staff members. One should also remember that the procedures are performed within facilities especially designed for ART, equipped with calibrated certified ART-equipments, using embryo-tested disposables, media products and procedures, proven to give high reproducible and consistent pregnancy rates. The couples are therefore given high value for money, but it also simultaneously reduces the time spent for auditing and increases the inflow of patients to the clinic.