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Designing a good ivf service
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SAWAD THOTATHIL
Designing a Best in class IVF program
Essentials – Components/Equipment/Infrastructure
Designing a good IVF lab– a different approach
Mostly the concern is about technological alternatives like microscopes, incubators etc
Why is that an incorrect approach?A good program is a patient centered
programA good lab only needs to support the patient
centerednessSo what do patients want?
Reasons and ongoing pregnancy numbers for couples (n = 319) that discontinued fertility workup and/or fertility treatment before conceiving an ongoing pregnancy, divided according
to the initiator (the couple or the fertility specialist).
Brandes M et al. Hum. Reprod. 2009;24:3127-3135
© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected]
Factors incorporated in design
Evidence-Based Design is the process of basing decisions about the built environment on credible research to achieve the best possible outcomes.
Service offerings – Treatment offeringsQuality of the service – Various dimensions of
service qualityType of patient – Values, choices, affordability
Design choices impact
Layout and interiorsTechnology and equipment choices Systems and protocols– Functioning of the
entire clinical unit including the people, their roles, protocols for activities and information technology
Cost of establishment, running costs, pricing of services
Elaboration of the patient centered or EBD approach in the following slides……
Service offerings
Standard - standard (IVF/ICSI)Biological plausible yet unproven (low oxygen
culture, IMSI, metabolic screening of embryos)Experimental (Pre-implantation screening PGS
of gene expression for embryo selection, in-culture video monitoring)
IMPACT Additional space , equipment and scientific staff Cost of project can double the cost of a standard IVF/ICSI lab ex: PGS IMSI can result in 15 to 20 % cost increase Example: Low oxygen culture is likely to be beneficial for embryo
culture but you have to buy different type of incubators (some more costly), running costs are slightly higher for the gas
Dimensions of service quality
Patient centeredness – concerns and desires of the patient are the chief determinant of decision making by the treatment provider
Timely – Care when it is neededSafety of patients and staffEffective – Service or treatment procedure
has been proven in a clinical environmentEfficient – avoiding wastage in materials,
time etc because the costs are ultimately passed onto the patient
Interiors
Effect of construction materials on embryo growthImpact of interiors on patient experience – air
quality, privacy, space etcChoosing materials require you to make choices
regarding the various quality specifications identified for each type of requirement. Ex: Quality specifications for table tops may be different from those required in the flooring
Information related to different materials have to be looked into as shown in the next 4 slides. Expert interpretation is required to avoid design errors
Clinic layout and impact on patient experience
Patient perception of quality of care is affected by the ambience
Space and layout should take into account the workflow ,expected workload and patient experience
1.Ex: Moving stretchers should go over a smooth surface without too many acute turns
2.Ex: Privacy between beds3.Ex: Comfortable seating for partner besides bed
Safety of embryos, patients and staff
Embryos -Monitoring of equipment (data logging equipment that continuously monitor incubator parameters, liquid nitrogen levels in the cryotanks)
Staff -Safety gloves and mask when handling liquid nitrogen
Patients – Falls prevention especially in the post anesthetic period
Effectiveness of service/treatment
Technology choices as mentioned beforeMore important dimension - How do
providers use the technology as individuals and teams?
Do you have standard operating procedures in place for quality control, embryo/patient safety? – Documentation is necessary for guidance, training
Do you have performance measurement in place? – database and patient management software is necessary for patient reports, data analysis
Timely care
This can mean different things in different care settings
Timely alerts, advises to patientsReminders also to staff to execute scheduled
activitiesTimely care can be provided only if there is a
team approach. Technology (ex: Concepta) can be used as an enhancer if budget allows
Technical choices during construction
Air conditioning or Air handlingElectrical system designGas supplies
Air handling
Particle filtrationVOC removalAir changes per hourTemperature controlConsiderations in design -Noise levels, room
size, external temperature, heat load in the room
Electrical system design
Categorize equipment and other needs Critical (zero tolerance to interruption)Critical (interruption allowed but needs back
up within minutes)Non critical with back up. Non critical without back upCalculate the loads and allot for backup with
UPS/Inverters/Generators as appropriate
Gas supplies
Quality of gas, adequacy of pressure at incubator end
Number of incubators now and in the futureLocation of cylindersBack up cylinders?Length of piping – cost and drop in pressureType of piping – copper pipes of numerous
types availableFilters
How do you go about it?
Project consultant – Expert with project management skills and good knowledge/experience establishing multiple IVF units.
Onsite Project lead – usually the architect Structure Interiors -General Electrical design Electrical execution contractor Lab/OT floor/wall Lab/OT ceiling Air handling unit for Lab/OT Gas piping for Labs Gas piping for OT and Recovery Lab Equipment Lab furniture Data logger LAN and telephone points General furniture Theatre equipment Start to finish – 12 weeks provided budget is approved, determination on the part of
the doctor and the space is constraint free for work
Role of the Project consultant
Understanding requirementsCommunicating with all stakeholdersGive design inputs : from layout to
technology to even lighting requirementsPlanningMonitoringClosing
Costs for mid size program (250 cycles per year)
Lab equipment – roughly about 50 lakhsOther furnishing/civil/interiors/electrical/theatre
equipment – another 20 lakhsCost reduction possible but not recommended if
you wish to create a good IVF programKey factors for success – contracting or hiring the
right people from architect to nurse to embryologistTraining and supervision for ovarian stimulation,
oocyte retrieval and embryo transfer proceduresStandard operating procedures, good protocols set
by experts
Real key to success
Patient experienceSatisfaction of patient needs
Executive education• Harvard Business school, Boston• Institute of Healthcare Improvement , Boston• Department of Health, South Australia• KPMG consulting, India
Contact details• 9594369996• [email protected]• Facebook and Linkedin “SAWAD THOTATHIL”• Facebook group “ Enabling better healthcare”
Sawad Thotathil
http://in.linkedin.com/in/sawadthotathilFacebook “sawad thotathil”Facebook group “ Enabling better healthcare’[email protected]