Improvement cycles
| PDSA cycle | Plan/prediction | Do | Study | Act/conclusions |
| A1 | Programme IDEAS to automatically generate Cycles data (53 variables required). Prediction Can be achieved (this time!). Will decrease TCT and DAT. | Train on IDEAS functionality (30 min) Design template to extract relevant variables (3 hours) Test on previous year’s data (2020) | 49 of 53 variables were extracted. Found that data in IDEAS had been entered reliably. DAT could be reduced by~2 min TCT will be unchanged | Worthwhile improvement and proof of principle. Needs refinement for remaining 4 of the 53 variables. |
| A2 | Troubleshoot and refine automated Cycles data extraction Prediction Cycles Book Spreadsheet can be retired. Will decrease TCT and DAT. | Discuss relevance of omitted variables. Refine programming to extract omitted variables (3 hours) Test on previous year’s data (2020) | Agreed three variables unnecessary. Extraction of 50/50 variables successfully automated. DAT will be reduced by 2.5 min TCT will be reduced by 7 days | Archive and retire the Cycles Book Spreadsheet – from now on generate a data worksheet on demand. IDEAS has further functionality worth exploring. |
| B | Use IDEAS to hold embryo location data (added in real time) Prediction Paper Freeze Cards can be retired | Amend standard operating protocols: Embryologist to add storage details onto IDEAS in real time in lab. Arrange lab meetings (many, online) to train staff and gather feedback. Run new and old systems in parallel during trial. Audit data entry errors. | OM not yet improved (10 days): downstream delays PM1 reduced from 5 to 1 days PM2 reduced from 10 to 4 days Retrospective audit error cause: Paper system: 85% IDEAS system: 15% All errors were resolved. Double witnessing system reduced errors to 0%. DAT slightly reduced, TCT unchanged | Clear benefits using new system → transcribe data from all current freeze cards onto IDEAS. Archive & retire paper Freeze Cards → use IDEAS data from now on. Continue audit to monitor data accuracy. Need to tackle more data entry delays to shift OM and TCT: Labsheets still waiting in multiple trays. |
| C | Use IDEAS to store all remaining lab process data (added in real time in the lab). Prediction Will take time for Embryologists to adjust: data input will be hit and miss - but will then further reduce TCT and DAT. | Give embryologists a demo, and send instructions to all (email). Post reminder sign at lab exit: ‘Have you put your procedures on IDEAS?’ | OM not reduced (10 days): problem when project leader absent; when returned reduced to 7 days. PM2 reduced from 4 to 1 days PM3 reduced from 11 to 4 days DAT reduced by~10 min to~18 min | Have now removed manual systems. Learning: Entry of IVF data to IDEAS (PM3) by Day six is adequate Important to have wider responsibility for stages. Investigate potential to switch from biennial to a rolling audit of storage tanks in cryostore. |
| D | Use continuing data audit to do the job of the biennial cryostore audit Predictions Can replace biennial audit (so reducing workload and risk of embryo thawing). | Conduct audit and a risk assessment to gauge the safety of switching to a rolling audit model | Rolling audit is satisfactory. Risk score reduced from 6 to 3 for accidental embryo thawing. | Cease biennial audit (removing two person-weeks of workload per 2 years and reducing risk): considered a major win! |
| E1 | Test to check system performance and whether sustained Prediction New protocols working, but delays expected (pending HFEA Form web interface) | Resume collecting and calculating all interval metrics | OM reduced from 10 to 5 days, delays due to interface as expected. Freeze data (PM1) 100% 0 delay, but delays evident downstream. Surprise!: Some gaps in OM data: 8 Freeze Letters had been missed: a flaw discovered in the system. TCT reduced to around 5 days | Fix freeze letter flaw and monitor. Recheck system performance when HFEA Forms interface running. |
| E2 | HFEA Form available: retest system performance check system performance and sustained levels Prediction System now has no external constraints, will be working close to optimal. | Resume collecting and calculating all interval metrics | All metrics have control limits within targets: statistically reliable. TCT reduced to 0 or 1 day. Project aims met. Getting close to vision of all admin data entry on the day of clinical activities. | A great success. Worthwhile to share our revised and safer processes with other IVF units. Continue with QI: consider what to address next. |
DAT, data administration time; HFEA, Human Fertilisation and Embryology Authority; IVF, in vitro fertilisation; OM, outcome metric; PDSA, Plan–Do–Study–Act; TCT, total cycle time.