Abstract
Purpose
To test whether an electronic whiteboard in the IVF laboratory increases the likelihood that critical evaluation procedures are performed within optimum pre-set time ranges.
Methods
A retrospective cohort study of oocyte retrievals in our IVF clinic between 06/01/2012 and 05/31/2018 was included. The electronic whiteboard was introduced on 04/06/2014. Prior to implementation, embryologists strived to adhere to the set evaluation times without a formal guide. The primary outcomes were the proportion of embryologist evaluations performed in optimum time ranges and the proportion of usable embryos per patient.
Results
A total of 4645 retrievals met inclusion criteria. Implementation of the whiteboard was associated with (1) an increase in the proportion of fertilization checks performed within the optimum time range for ICSI cycles (+ 5.1%, RR = 1.06, CI = 1.02–1.10); (2) an increase in the proportion of day 3 evaluations performed within the optimum time range, whether assisted hatching was performed (+ 23.6%, RR = 1.48, CI = 1.36–1.60) or not (+ 13.8%, RR = 1.23, CI = 1.12–1.35); and (3) an increase in the proportion of day 5 evaluations within the optimum time range (+ 15.5%, RR = 1.23, CI = 1.12–1.35). Additionally, the mean number of usable embryos per patient increased from 2.8 to 4.5 after the whiteboard was implemented (RR = 1.25, CI = 1.19–1.31).
Conclusion
The use of an electronic whiteboard that posts optimum times for performing critical procedures significantly increases the proportion of evaluations that occur within these ranges. Such improved standardization led to positive downstream effects on the number of usable embryos per patient. We suggest that electronic whiteboard implementation driven by real-time data collection should be considered in all IVF laboratories.
Supplementary Information
The online version contains supplementary material available at 10.1007/s10815-020-02007-x.
Keywords: Electronic whiteboard, IVF laboratory, Quality management, Embryo evaluation, Clinical outcomes
Introduction
A key component of a successful in vitro fertilization (IVF) program is a reliable IVF laboratory. Both the American Society for Reproductive Medicine and the European Society for Human Reproduction and Embryology have published requirements and practice guidelines for the IVF laboratory [1–3]. Due to the complex processes that occur in the laboratory, a quality management program is required to maintain the standardized performance that is expected and to monitor the staff’s adherence to these established standards [4–7].
One tool, which has increasingly been implemented in clinical settings to improve information accuracy and overall workflow, is an electronic whiteboard. These electronic screens generally display necessary information about each patient and the status of tasks related to the care of individual patients, often replacing manually updated dry-erase whiteboards [8]. Studies have been performed to investigate the effect of electronic whiteboards on care processes and patient outcomes in the emergency department and operating theater [9]. The ability of an electronic whiteboard to provide accurate, up-to-date, and accessible information has been shown to improve workflow and decrease handoffs and task interruptions among clinical staff [9–12].
In 2014, we introduced an electronic whiteboard into our IVF laboratory with the goal of aiding our embryologists to perform tasks within optimum pre-set intervals. The whiteboard, which is programmed from our internally developed software that captures data real time at the bench, displays the optimum time that each procedure should be performed for each evaluation and procedure.
In the present study, we evaluated whether the implementation of our electronic whiteboard improved embryologist performance by increasing the likelihood that the fertilization check and day 3 and day 5 evaluations were performed within our standardized time ranges and that by tightening these times, there was an increase in the proportion of embryos deemed clinically useful. Secondarily, we compared the mean evaluation times among all embryologists with the mean targets for each procedure, before and after implementation of the whiteboard.
Materials and methods
Study population
This was a retrospective cohort study of IVF/ICSI cycles performed in our institution between 06/01/2012 and 05/31/2018. Cycles were excluded if no oocytes were retrieved or if in vitro maturation or a split IVF/ICSI insemination was performed. In addition, evaluations were excluded if they were performed by an embryologist who began working in our laboratory after the study period had begun or who left our laboratory before the end of the study period. This approach reduced sampling bias by removing embryologists who were not employed in the lab during the entire study period.
In total, there were nine embryologists who met inclusion criteria. Each embryologist performed an average of 20 cycles per week during the study period. Our embryology team has been stable for many years and all embryologists included in the study had a minimum of 5 years of experience after achieving certification to perform the procedures for which they were included. Except for one of the embryologists, who took a 3-month maternity leave, all others worked uninterrupted throughout the study period other than taking time for the usual 1- or 2-week vacation. The performance of the one embryologist who was on maternity leave was not affected by this leave of absence (data not shown).
Ethical approval
This study was approved by the Institutional Review Board at our institution (Protocol #2018P002360) with a waiver for informed consent.
Data collection, database, and electronic whiteboard
All embryology data in our laboratory are entered real time into our internally developed software as evaluations are performed at the bench. The embryologist signs into the system the first time they are going to handle patient material and they are able to remain logged in as they complete a set of procedures. The embryologist documents the time that each procedure is started and finished (i.e., for an oocyte retrieval) or that a procedure is completed (i.e., for insemination). For patient safety and procedure monitoring purposes, two embryologists electronically confirm that the sperm and oocytes have been correctly identified for each procedure.
The electronic whiteboard was developed in collaboration with a medical software company (Boston Advanced Analytics Inc., Boston, MA, USA). The software for this program works in conjunction with and is required to have an electronic program to capture embryology data that is designed by the same company. This software can be obtained by directly contacting the software company. The software is connected to our electronic whiteboard, which is programmed to display the optimum times that each task should be performed for every patient, based on previous quality control work. The whiteboard can be viewed on computer screens and is displayed on large monitors in the laboratory.
Figure 1 shows a typical electronic display after work has begun for the day. The time of day is shown in the far left column with each type of evaluation listed across the top row (fertilization check, oocyte retrievals, thaws, transfers, etc.). At the beginning of the day, all patient names are highlighted in bright yellow to signify that no tasks have been started. The highlight changes to pale yellow when a task has been initiated but not completed and then changes to white once completed. At the beginning of each day, all names should be highlighted in bright yellow; at the end of the day, none should be highlighted. In addition, the number of oocytes or embryos is listed for each patient so the embryologist can better plan the amount of time to allot for a given evaluation or procedure. Of note, when two patients share the same last name (in the cases shown, “Aaa”), the names appear in red as an alert.
Fig. 1.
Typical electronic display after work has begun for the day
All data is archived in our prospectively maintained IVF database. This database is routinely audited twice yearly.
Study design
The software and electronic whiteboard were introduced into our laboratory on 04/06/2014. Cycles were stratified into the pre-electronic whiteboard group and the post-electronic whiteboard group. The pre-electronic whiteboard group comprised cycles performed from 06/01/2012 to 04/05/2014. In the time period before implementation of the electronic whiteboard, all documentation was completed using paper forms. The embryologists were aware of the optimum times to perform each procedure but they did not have a real-time monitoring guide. The post-electronic whiteboard group included cycles performed from 03/01/2015 to 05/31/2018. The 11 months after the electronic whiteboard was implemented (04/06/2014–02/28/2015) were defined as a transition period and were excluded.
Laboratory protocols
Following retrieval, oocytes were either inseminated in groups (3–5 oocytes) or underwent ICSI. A fertilization check was then performed, with the goal for this to be completed within the optimum time range of 16–18 h post-insemination/ICSI. Zygotes with two pronuclei (2pn) were cultured individually in 25 μL droplets of Global Total medium (CooperSurgical, Trumbull, CT) overlain with mineral oil in 5% O2, 6–7% CO2 balanced with N2. Embryos were evaluated on day 3, with the goal for this to be completed within the optimum time range of 65–67 h post-insemination/ICSI. Day 3 embryos were evaluated for cell number, fragmentation, and degree of asymmetry [13]. Embryos that were cultured beyond day 3 were then re-evaluated on day 5, with the goal for completion to be within the optimum time range of 114–117 h post-insemination/ICSI. Day 5 embryos were staged (arrested, early, or late morula or blastocyst with the extent of expansion) and the quality of the inner cell mass and the trophectoderm was recorded. The optimum time ranges for assessment at our center have been established based on an internal review of our data and are similar to those recommended by expert consensus [14]. There were no changes in any laboratory standard operating procedure or in the culture system during the study period except for an increase in usage of ICSI. The number of usable embryos for each patient was defined as the number of embryos cryopreserved plus the number of embryos transferred in the fresh cycle.
Statistical analyses
For the primary analyses, evaluation times at the fertilization check, and for day 3 and day 5 assessments, as well as the proportion of usable embryos, were compared between the two study groups. Furthermore, stratified analyses were performed for fertilization check (ICSI and IVF strata) and day 3 (assisted hatching presence/absence strata). The analyses which evaluated the proportion of usable embryos, the fertilization outcomes, and the day 3 embryo outcomes were adjusted a priori for patient age (Table 3, Supplemental Tables 1 and 2). The small number of trophectoderm biopsies performed prior to the electronic whiteboard (n = 48) limited the sub-analysis of day 5 assessments (i.e., biopsy or not). Therefore, we did not include stratification by trophectoderm biopsy in the final analysis; however, we adjusted for trophectoderm biopsy cycles in the analysis of day 5 assessments. Generalized estimating equations (GEE) log-Poisson modeling using an exchangeable correlation structure to account for correlation within embryologists was used to estimate risk ratios and 95% confidence intervals for evaluations within the optimum time range.
Table 3.
Comparison of the number of usable embryos per patient
| Before electronic whiteboard N = 8027 | After electronic whiteboard N = 19,835 | Risk ratio* (95% CI) | |
|---|---|---|---|
| Median (IQR) number of usable embryos per patient | 2 (0–4) | 4 (2–6) | 1.25 (1.19, 1.31) |
| Mean (SD) number of usable embryos per patient | 2.8 (3.2) | 4.5 (4.0) | |
| Median proportion usable embryos per patient | 33.3% | 46.7% |
Usable embryos defined as the number of embryos transferred plus cryopreserved embryos
*Adjusted a priori for patient age
A secondary descriptive analysis to compare the mean evaluation time of each individual embryologist before and after implementation of the whiteboard was performed. All data manipulations and analyses were generated using SAS/Base and SAS/STAT software, Version 9.4 of the SAS System for Windows (Copyright © 2013 SAS Institute Inc., Cary NC).
Results
A total of 4645 retrievals were included: 1666 in the pre-electronic whiteboard group and 2979 in the post-electronic whiteboard group. Demographic characteristics for the patients in each group are shown in Table 1. All characteristics analyzed were similar between the two groups except for the use of ICSI and trophectoderm biopsy, which were both greater in the post-electronic whiteboard group (44.5% versus 55.6% for ICSI and 4.4% versus 17.5% for trophectoderm biopsy).
Table 1.
Demographic characteristics among the study population
| Before electronic whiteboard N = 1666 | After electronic whiteboard N = 2979 | |
|---|---|---|
| Patient age at oocyte retrieval | 36.9 ± 4.5 | 36.5 ± 4.6 |
| Race | ||
| Caucasian | 1151 (69.1%) | 2036 (68.4%) |
| African American | 96 (5.7%) | 138 (4.6%) |
| Hispanic | 81 (4.9%) | 78 (2.6%) |
| Asian | 217 (13.0%) | 448 (15.0%) |
| Other/declined | 121 (7.3%) | 279 (9.4%) |
| BMI at oocyte retrieval (kg/m2) | 25.9 ± 6.5 | 25.9 ± 6.2 |
| Primary infertility diagnosis | ||
| Anovulation/PCOS | 105 (6.3%) | 194 (6.5%) |
| Diminished ovarian reserve | 421 (25.3%) | 768 (25.8%) |
| Endometriosis | 87 (5.2%) | 166 (5.6%) |
| Male | 307 (18.4%) | 554 (18.6%) |
| Tubal | 74 (4.4%) | 124 (4.1%) |
| Unknown | 543 (32.6%) | 816 (27.4%) |
| Uterine | 1 (0.1%) | 9 (0.3%) |
| Other | 128 (7.7%) | 348 (11.7%) |
| Multiple infertility diagnoses | 388 (23.3%) | 753 (25.3%) |
| Day 3 FSH (IU/mL) | 8.3 ± 4.0 (N = 1558) | 8.4 ± 4.2 (N = 2696) |
| AMH (ng/mL) | 2.3 ± 3.5 (N = 470) | 3.3 ± 3.9 (N = 2800) |
| Oocytes retrieved | N = 18,561 | N = 35,425 |
| Metaphase II | 16,227 (89.0%) | 30,577 (86.8%) |
| Late telophase I | 0 (0.0%) | 373 (1.1%) |
| Early telophase I | 0 (0.0%) | 610 (1.7%) |
| Metaphase I | 1317 (7.3%) | 2108 (6.0%) |
| GV (prophase I) | 402 (2.2%) | 1075 (3.1%) |
| Other | 285 (1.5%) | 502 (1.4%) |
| ICSI | 741 (44.5%) | 1657 (55.6%) |
| PGT biopsy | 48 (4.4%) | 368 (17.5%) |
BMI, body mass index; kg, kilograms; m, meter; FSH, follicle-stimulating hormone; AMH, anti-Mullerian hormone; GV, germinal vesicle; ICSI, intracytoplasmic sperm injection; PGT, preimplantation genetic testing; N, number of cycles. Data are mean ± standard deviation or N (%)
The proportion of evaluations before and after whiteboard implementation that were performed in the optimum time ranges at the fertilization check; the day 3 check and the day 5 check are shown in Table 2. At the fertilization check, significantly more evaluations were undertaken in the optimum time range for ICSI cycles after the implementation of the electronic whiteboard (88.8% vs. 83.7%; + 5.1%, RR 1.06 [95% CI 1.02–1.10]). This change was driven by a 9.2% decrease in evaluations that were performed less than 16 h post-injection, after the intervention. In contrast, there was no difference in the proportion of evaluations performed in the optimum time range for traditional insemination cycles post-whiteboard use (88.6% vs. 87.0%; + 1.6%, RR 1.02 [95% CI 0.98–1.06]).
Table 2.
Proportion of embryo evaluations performed in the optimum time range
| Before electronic whiteboard | After electronic whiteboard | Percent change (%) | Risk ratio (95% CI) | |
|---|---|---|---|---|
| Fertilization check, ICSI | N = 741 | N = 1657 | ||
| Within range (16–18 h PI) | 620 (83.7%) | 1471 (88.8%) | 5.1 | 1.06 (1.02, 1.10) |
| < 16 h PI | 109 (14.7%) | 91 (5.5%) | − 9.2 | 0.37 (0.25, 0.54) |
| > 18 h PI | 12 (1.6%) | 95 (5.7%) | 4.1 | 3.14 (1.96, 5.03) |
| Fertilization check, IVF | N = 925 | N = 1322 | ||
| Within range (16–18 h PI) | 805 (87.0%) | 1171 (88.6%) | 1.6 | 1.02 (0.98, 1.06) |
| < 16 h PI | 64 (6.9%) | 41 (3.1%) | − 3.8 | 0.44 (0.31, 0.62) |
| > 18 h PI | 56 (6.1%) | 110 (8.3%) | 2.2 | 1.34 (0.98, 1.84) |
| Day 3 check, AH | N = 984 | N = 1305 | ||
| Within range (65–67 h) | 485 (49.3%) | 951 (72.9%) | 23.6 | 1.48 (1.36, 1.60) |
| < 65 h | 87 (8.8%) | 112 (8.6%) | − 0.2 | 0.91 (0.73, 1.13) |
| > 67 h | 412 (41.9%) | 242 (18.5%) | − 23.4 | 0.46 (0.39, 0.54) |
| Day 3 check, no AH | N = 604 | N = 1471 | ||
| Within range (65–67 h) | 367 (60.8%) | 1098 (74.6%) | 13.8 | 1.23 (1.12, 1.35) |
| < 65 h | 61 (10.1%) | 150 (10.2%) | 0.1 | 1.02 (0.79, 1.34) |
| > 67 h | 176 (29.1%) | 223 (15.2%) | − 13.9 | 0.53 (0.38, 0.73) |
| Day 5 check* | N = 1104 | N = 2105 | ||
| Within range (114–117 h) | 646 (58.5%) | 1558 (74.0%) | 15.5 | 1.26 (1.16, 1.37) |
| < 114 h | 43 (3.9%) | 276 (13.1%) | 9.2 | 3.21 (2.27, 4.54) |
| > 117 h | 415 (37.6%) | 271 (12.9%) | − 24.5 | 0.35 (0.27, 0.46) |
ICSI, intracytoplasmic sperm injection; PI, post-insemination; IVF, in vitro fertilization; AH, assisted hatching; N, number of cycles. Data are mean ± standard deviation or N (%)
*Adjusted for preimplantation genetic testing biopsy cycles
At the day 3 check, there was a statistically significant increase in the proportion of cycles that were evaluated in the optimum time range, regardless of whether assisted hatching was used. For assisted hatching cycles, an increase from 49.3 to 72.9% (+ 23.6%, RR 1.48 [1.36–1.60]) was observed. This change was driven by a 23.4% decrease in evaluations performed greater than 67 h post-insemination, after whiteboard use. For non-assisted hatching cycles, an increase from 60.8 to 74.6% (+ 13.8%, RR 1.23 [1.12–1.35]) was observed, which was driven by a 13.9% decrease in evaluations performed greater than 67 h post-insemination.
At the day 5 assessment, whiteboard use was associated with a statistically significant increase in the proportion of embryos evaluated in the optimum time range (74.0% versus 58.5%; + 15.5%, RR 1.26 [1.16–1.37]). This change was driven by a 24.5% decrease in evaluations that were performed greater than 117 h post-insemination. No statistically significant difference in the distribution of embryos by the blastocyst stage was observed before and after the intervention (data not shown).
Among all cycles, the proportion of mature oocytes identified with 2pn at the fertilization check was statistically increased from 66.0 to 68.8% (+ 2.8%, RR 1.03 [1.01–1.05]) after the implementation of the electronic whiteboard (Supplemental Table 1). At the day 3 evaluation, the proportion of embryos which were observed to have ≥ 8 cells statistically significantly increased by + 3.1% after the implementation of the electronic whiteboard (57.3% versus 60.4%; RR 1.05 [1.02–1.08]). The total number of cells observed for each embryo before and after the implementation of the electronic whiteboard is shown in Supplemental Table 2. The mean number of usable embryos available per patient also statistically significantly increased from 2.8 ± 3.2 embryos to 4.5 ± 4.0 after the implementation of the electronic whiteboard (RR 1.25 [1.19–1.31]) (Table 3).
Figure 2 shows the mean evaluation times by each embryologist for the fertilization check (ICSI and IVF cycles, Fig. 2a and b, respectively) and for day 3 (Fig. 2c) and day 5 evaluations (Fig. 2d). Among all embryologists, the change in mean evaluation time for ICSI oocytes before and after whiteboard implementation was 0.4 h, which resulted in overall team performance being closer to the midline for the optimum evaluation time (i.e., 17 h; Fig. 2a). In contrast, there was a small shift of 0.2 h away from the midline for inseminated oocytes (Fig. 2b). The change in mean evaluation time for day 3 embryo evaluations was 0.5 h closer to the midline of the optimum evaluation time range (i.e., 66 h; Fig. 2c). Lastly, the change in mean evaluation for day 5 embryo evaluations was 1.2 h closer to the midline of the optimum evaluation time range (i.e., 115.5 h, Fig. 2d).
Fig. 2.
The mean evaluation times by each embryologist for the fertilization check and for day 3 and day 5 evaluations (a–d)
Discussion
The present study was conducted to assess whether the implementation of our electronic whiteboard increased the likelihood that critical evaluations are performed within standardized pre-set time ranges in our laboratory. The results show a statistically significant improvement in embryo evaluations occurring in the pre-set time range for every evaluation analyzed except for the fertilization check in traditional insemination cycles, in which no change was observed. Secondarily, the mean evaluation time for the embryology team shifted closer to the midline of optimum time ranges for all evaluations except for one; the mean evaluation time for the fertilization check in traditional insemination cycles shifted slightly away from the midline. Additionally, a significant increase in the number of zygotes, good quality day 3 embryos, and usable embryos per patient was observed after the implementation of the electronic whiteboard.
A quality management program in the IVF laboratory is crucial to ensure stable performance for the optimization of patient care. Such a program must entail constant monitoring of all equipment and contact materials and assurance of a pristine ambient environment free of air pollutants and other toxins. Equally important, an effective quality management program must include monitoring of personnel performance, which should incorporate not only training and certification to perform the procedures undertaken but also surveillance of individual performance to ensure that procedures are performed within optimum time intervals. To this end, our electronic whiteboard was installed to provide visual cues to aid adherence by embryologists to establish standards for performing the time-sensitive procedures. The overall goal of this tool is to ensure patient safety, maximize efficiency, and help maintain consistency in performance within our laboratory.
To our knowledge, we are the first IVF laboratory to implement and assess the impact of an electronic whiteboard that displays the evaluation times and the schedule of procedures performed each day. Electronic whiteboards have been utilized in other medical fields to increase visibility and access to necessary clinical information so as to improve clinical workflow and patient outcomes [8, 9]. The advantage of an electronic IVF laboratory schedule linked to the medical record is that it can be automatically updated in real time as evaluations are initiated and completed and can be broadly displayed throughout the laboratory for ease of access. Prior to the implementation of our electronic whiteboard, the daily schedule was recorded on a single piece of paper and required labor-intensive maintenance and oversight for manually updating throughout the day.
The present findings reveal that the electronic whiteboard improved the embryologists’ overall ability to perform evaluations within the optimum pre-set time ranges for each of the three procedures analyzed (fertilization check and days 3 and 5 evaluations). When the cycles were stratified by whether a further procedure was involved (i.e., ICSI or assisted hatching), the only intervention not associated with improvement in time range adherence was for the fertilization check with traditional insemination. The benefit of the electronic whiteboard is further supported by our findings of a significantly increased number of zygotes, good quality day 3 embryos, and the total number of usable embryos per patient after the whiteboard was implemented. While there are many patient-, treatment-, and laboratory-specific factors which ultimately contribute to these clinical outcomes, these results are consistent with the improvement in the embryologists’ overall performance of evaluations within the optimum pre-set time range that were observed after the implementation of the electronic whiteboard.
We attribute the whiteboard’s real-time updates of the daily schedule and its broad display throughout our laboratory, as key functions that led to the improvements observed in this study. Compared to a manually updated paper schedule, the electronic whiteboard guided the embryologists to perform the evaluations within the optimum time range. For example, after whiteboard implementation, an increased proportion of fertilization checks was performed in the optimum time range for ICSI cycles, which was attributed largely due to a significant decrease in fertilization checks being performed prior to 16 h. Yet, for traditional insemination cycles, no improvement was observed. Despite our laboratory protocol requiring ICSI to be performed 3–5 h post-retrieval and traditional insemination 4–6 h post-retrieval, further analyses showed a drift towards both insemination types being done at approximately the same number of hours after retrieval. As fertilization checks for both insemination types were occurring at approximately the same time of day and because ICSI procedures take more time than traditional inseminations, shorter durations were occurring between ICSI and the fertilization check. The electronic whiteboard mitigated this detrimental shift by displaying the ideal times that ICSI (3–5 h post-retrieval) and traditional insemination (4–6 h post-retrieval) should occur, as well as the ideal time to perform the corresponding fertilization checks. ICSI fertilization checks were thus shifted into the optimum time range, as per our laboratory protocol.
We acknowledge the limitations of our study. Firstly, this is a retrospective study and we were unable to control for all variations that may occur throughout the day in an IVF laboratory. However, we attempted to eliminate sampling bias for embryologists by including only those who were on our team throughout the duration of the study period. While all embryologists in this study had a minimum of 5 years of experience prior to the beginning of the study period, it is possible that their technical skills continued to improve throughout the duration of the study which could have positively affected both their adherence to the optimum time ranges and the fertilization rates and embryo development outcomes that we report. Secondly, the applicability of our optimum pre-set time intervals for the procedures evaluated may not be transferable to all IVF laboratories due to differences in protocols and workflow. Thirdly, due to changes in clinical practice over time regarding the use of preimplantation genetic testing and freeze only cycles, we were unable to assess whether there was an increase in clinical outcomes after implementation of the electronic whiteboard. Finally, as laboratory techniques and procedures are continuously improved over time, it is possible that some of the significant improvements in fertilization rates and embryo development that we report were in some part due to improvements in laboratory and clinical treatment methods. Nevertheless, our collective findings indicate that even when specific time intervals for undertaking evaluations are stipulated and when every attempt to adhere to these time intervals is made by an excellent embryology team, such as that at our hospital, implementation of an electronic whiteboard further tightens embryologist performance.
Conclusions
In summary, this study demonstrates that the implementation of an electronic whiteboard, which posts times for performing critical procedures in the IVF laboratory, significantly improves the proportion of evaluations that occur in the optimum time ranges. Such improved standardization led to positive downstream effects on the number of usable embryos per patient. As our field continues to develop more advanced treatment options and improved laboratory techniques, there is an increased level of procedural and scheduling complexity, which will require ever-increasing careful coordination. This has the potential to lead to variability and near misses in the IVF laboratory if appropriate monitoring is not in place. Quality management tools, such as our electronic whiteboard, serve to improve standardization and decrease variation within the IVF laboratory to enable a more reliable assessment of embryologist competencies in performing laboratory procedures. An electronic whiteboard connected to a database that collects real-time data at the bench improves quality control and enhances patient safety by providing visual cues to aid embryologists in their ever-increasingly complex work in the clinical IVF laboratory. We suggest that electronic whiteboard implementation driven by real-time data collection should be considered in all IVF laboratories.
Supplementary information
(DOCX 13 kb).
(DOCX 14 kb).
Acknowledgments
We would like to thank all members of our embryology team at Brigham and Women’s Hospital for their enduring commitment to provide the highest quality of care to each patient.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
IRB approval
This study was approved by the Partners Institutional Review Board at the Brigham and Women’s Hospital (Protocol #2018P002360) with a waiver for informed consent.
Footnotes
This study was presented as an oral at the American Society for Reproductive Medicine Annual Conference, October 14th, 2019, in Philadelphia, PA.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Materials
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