Table 1

Improvement cycles

PDSA cyclePlan/predictionDoStudyAct/conclusions
A1Programme IDEAS to automatically generate Cycles data (53 variables required).
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.
A2Troubleshoot and refine automated Cycles data extraction
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.
BUse IDEAS to hold embryo location data (added in real time)
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.
CUse IDEAS to store all remaining lab process data (added in real time in the lab).
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.
DUse continuing data audit to do the job of the biennial cryostore audit
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 modelRolling 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!
E1Test to check system performance and whether sustained
New protocols working, but delays expected (pending HFEA Form web interface)
Resume collecting and calculating all interval metricsOM 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.
E2HFEA Form available: retest system performance check system performance and sustained levels
System now has no external constraints, will be working close to optimal.
Resume collecting and calculating all interval metricsAll 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.