Safety, Efficacy, and Complexities in ART Practice

Physician Commentary

William F. Gibbons, M.D.

Disclosures

Semin Reprod Med. 2012;30(3):167-172. 

In This Article

Abstract and Introduction

Abstract

There are few patient care processes for which a team approach is more important than for assisted reproduction. Close, continuous communication is required at many levels among physicians, nursing staff, therapists, the various laboratories, and patients. Quality of care is associated with the reduction of medical errors through processes of risk management, mechanisms to allow the safe evolution of assisted reproductive technology care within the clinic, and how clinics ethically communicate with team members and with patients through informed consent and direct and honest interaction.

Introduction

An assisted reproductive technology (ART) program cannot be seamlessly separated into divisions of clinical and laboratory. There are few other patient care processes for which a team approach is more important than for an ART program. Regular interaction daily, weekly, and monthly is required to assure that couples are adequately prepared, that, in the clinic, biochemical and ultrasound parameters are managed daily, and that interaction occurs to provide efficient scheduling of examinations, aspirations, and embryo transfers. The progress of an ART program at the month-to-month interval includes feedback and quality control and involves the shared decision making of the entire team to improve outcomes. Communication is the watchword because it is necessary at so many levels.

Commentary from physicians across the country emphasizes the importance of communication and the issues that promote and antagonize the flow of information between the clinic and the embryology laboratory. Communication relies not only on the use of aids such as electronic medical records but also on established procedure protocols and regular face-to-face interactions of the clinical and laboratory teams. The multiple sources of gametes and uteri, types of physicians involved (reproductive endocrinologists, urologists, affiliated physicians providing medical clearance, preconceptual counseling, and previous medical procedures/records) and required federal and state regulatory documentation can produce an environment of controlled chaos that must be managed.

Preparation for writing the introduction to this issue involved questioning of physicians from one side of America to the other about issues of communication and about policies they have established within the scope of their ART programs. Some of their observations and solutions are set out here and include ways of dealing with medical error and its disclosure, as well as risk management, process mapping, informed consent, and research.

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