Preventing errors in the IVF Lab is the top priority of every embryologist. But how do they happen, and what can we do about them?
Have you ever driven home, but didn’t know how you got there? That’s your brain on autopilot mode. Brain scans have revealed that when your mind wanders, it switches into this mode to enable you to carry on doing tasks quickly and reasonably accurately, but without conscious thought.
“Autopilot mode” one of the most dangerous times for an embryologist. Reasonable accuracy is not acceptable in what we do. Yet, as human beings, we all make errors. Sometimes, your brain and eyes just don’t see what’s right there in front of you.
Part of embryologist training is not just learning the technical procedures, but training your brain to not take “shortcuts.” We do this by implementing a set of tricks to constantly kick the grey matter from autopilot mode back into full consciousness on a regular basis. Each embryologist must develop their own magic set of tricks to ensure nearly 100% accuracy, always. The eyes of a junior embryologist must be trained to actually SEE what is in front of them, and to not accept what our brain wants us to see, or what one THINK they should be seeing (i.e. seeing an empty dish when there are really embryos in it!). Even “seniors” can be lulled I into complacency by many years without an error, until and unexpected are truly horrific mistake happens out of the blue.
The unique nature of IVF and fertility care demands an incredibly high standard to avoid errors. This makes embryology a medical professions with one of the highest rates of stress and burnout. You can never just “put it on autopilot” or lose concentration, even for a second. The consequences can be catastrophic for both patients and the clinic.
While mistakes may occasionally be due to system failures, malfunctioning equipment, or a break in the chain of custody, the hardest type to deal with, especially in the lab, is simple human error.
Here are 4 tips to prevent human error in the IVF lab.
- Declutter work spaces and always clean the entire space, including discarding pipette tips between handling patient specimens.
- Take breaks in between similar procedures. Practice the last “pause” before any tissue leaves your hand.
- Eliminate the “hand off” so that an embryologist finishes each procedure from start to finish.
- Say each patient’s name out loud (or embryo number) when moving between embryos or patients.
In fertility care, any instance in which gametes or embryos are lost, degraded, or misdirected constitutes an adverse event – a medical error. The comprehensive training and accreditation of an embryologist is designed to minimize any potential impact on patient samples.
Fortunately, IVF errors are rare. A study published recently found that in a 10-year period (2009 to 2019), 133 errors occurred that resulted in lawsuits out of approximately 2.5 million IVF procedures in the U.S. A 2018 study of non-conformance with standards from the International Organization for Standardization found that 99.96% of procedures (36,654 IVF treatment cycles) in one clinic network had zero violations.
I’ve had both my best day and my worst day as an embryologist. While research on the unconscious mind has shown that the brain makes judgments and decisions quickly and automatically, I look forward to an AI-enabled lab, where repetitive and mundane tasks are automated and intelligent, AI-enabled tools monitor and control safety with precision and ease.
Do you have story to share when an error occurred in the lab and you were able to correct it?