Doing today's work today: real-time data recording and rolling audit in an IVF clinic

Abstract

The assisted conception unit at Sheffield Teaching Hospital NHS Foundation Trust provides in vitro fertilisation treatment. A team of seven embryologists provides a routine clinical laboratory service, involving culture and storage of embryos. This requires a series of management and statutory data administration and communication tasks.We were aware that these were often done many days after clinical tasks, resulting in delays sending patient correspondence and unavailability of clinical notes for multidisciplinary team (MDT) cycle-review meetings. Embryologists also complained that transcribing data were time-consuming and duplicated across our IDEAS software, spreadsheets and paper.We process-mapped our processes and gathered staff views on problems and potential solutions. The baseline average total cycle time (TCT) for completion of all administrative steps was around 17 days; data administration time (DAT, data 'touch time') was around 30 min per patient.We embarked on this Quality Improvemen (QI) project to reduce waste in TCT and DAT, and to have data available for patient communication and MDT deadlines. Exploration of IDEAS' capabilities led to progressive realisation of how much could be transferred to this single data system, removing a lot of off-putting redundancy. Through this we developed a 'to-be' vision of all data entry being real time, as part of the clinical 'jobs'. We conducted five Plan-Do-Study-Act cycles plus two more to test performance and sustainability as changes bedded-in and an external constraint disappeared.We have cut TCT to 0 or 1 days and DAT to around 18 min. All project metrics are reliably within our targets, and data are now always available for timely patient letters and the MDT. Other benefits include easy access for all staff to patient records and removal of paper and spreadsheets. A further, unanticipated, benefit was a switch from a tedious 2 yearly storage tank audit to a more-agreeable and safer rolling audit.

Keywords: continuous quality improvement; efficiency, organizational; information technology; process mapping; statistical process control.

Figure 1

Process maps of administration involved in a patient IVF cycle at ACU. Left: As-Was (original) Condition Right: As-Is (current) Condition red=unnecessary waste, Orange=necessary waste, Green=value adding steps. We’ve distinguished between a darker green representing value from the point of view of the patient and clinicians involved in the cycle, and a lighter green which are or were clear value to ACU to ‘do the job’ or comply with regulation. Blue are clinical activities important to time anchors. *Some expediting when long delays were noticed. (PDSA E1 Is not shown—it was a ‘go-and-see’, without a predesigned change intervention), interval between embryo freezing and generating the Freeze Letter for the patient (days) PM1 = Process Metric 1: interval between embryo freezing and inputting the freeze data to IDEAS (days) PM2 = Process Metric 2: interval between day 0 and inputting the egg data to IDEAS (days) PM3 = Process Metric 3: interval between day 0 and completing entry of all the IVF insemination data to IDEAS (days). ACU, assisted conception unit; ‘day 0’, egg collection from the patient; DAT, data administration time; IDEAS, IVF database software system; ITT, intention to treat; IVF, in vitro fertilisation; MDT, multidisciplinary team; OM, outcome metric; PDSA, Plan–Do–Study–Act; TCT, total cycle time.

Figure 2

Performance metrics: OM and PM1 (PM2 and PM3 are in online supplemental file 1). IVF, in vitro fertilisation; MDT, multidisciplinary team; OM, outcome metric; PDSA, Plan–Do–Study–Act.