SAWAD THOTATHIL

Designing a Best in class IVF program

Essentials – Components/Equipment/Infrastructure

Professional development programs• Harvard Business school• Institute of Healthcare Improvement • Department of Health, South Australia• KPMG consulting

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: journals.permissions@oxfordjournals.org

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

EBD factors impact the following

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 this 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 growth

Impact of interiors on patient experience – air quality, privacy, space etc

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 and technology (ex: Concepta) can be used as an enhancer

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 as in next slide (example:

lighting requirements)PlanningMonitoringClosing

Room Station User requirement FootcandleColor temp CRI Additional comments

2 IVF theatre

3  GeneralBright, body color preserved 150 5000 plus 85 plus Dimmer option

4 Anesthesia Must have optional lighting when general light is dimmed

5000 plus

5

6 Surgical lightBright, body color preserved 5000 plus 85 plus

Must be able to move and direct to pelvic areas

7 8 Minor OT

9 GeneralBright, body color preserved 150 5000 plus 85 plus Dimmer option

10 Anesthesia Must have optional lighting when general light is dimmed

11

12 Surgical lightBright, body color preserved 85 plus

Must be able to move and direct to pelvic areas

13 14 IVF lab General Bright, Day light color 6500 plus 85 plus 15 16 Consulting General 100 5000 plus 80 plus

17 Examination bedBright, body color preserved 100 5000 plus 80 plus

18 Desk 50 5000 plus 80 plus 19 20 Corridors 50 5000 plus 21

22Recovery bed General

Bright, body color preserved 150 5000 plus 85 plus

Dimmer option, no direct light on patient bed

23 Nurse station 150 5000 plus 85 plus

24waiting room

Bright, Day light color, enough to read, relax 6500 plus 85 plus

25

26 General Avoid position causing glare on screens

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

Sawad Thotathil

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