Risk factors for mismatches in the ART laboratory: an analysis of 73,719 electronic witnessing points. Forbrig M, Peirce K, Copeland C, Natalwala J, Chapple V, Liu Y. Reprod Biomed Online. 2024 Oct 23;50(5):104500. doi: 10.1016/j.rbmo.2024.104500. Epub ahead of print. PMID: 40106886

The manuscript explores risk factors associated with mismatches in assisted reproductive technology (ART) laboratories, using data from an electronic witnessing system (EWS). The study examines 73,719 witnessing points from 11,210 consecutive treatment cycles performed between 2016 and 2023. The research specifically identifies factors influencing both mismatches, which involve or do not involve biological material, and critical mismatches (CMM), which directly involve biological material.

Key findings include:

1. Mismatch Rates: A mismatch rate of 0.19% and a CMM rate of 0.02% were observed. The mismatch rate peaked between 12 pm and 2 pm, and the CMM rate was highest after 4 pm.
2. Laboratory Processes: Specific laboratory processes, including oocyte denudation, embryo transfer, and cryopreservation, were associated with higher mismatch rates, while oocyte denudation and embryo transfer showed significant CMM rates.
3. Operator Factors: The study also highlighted variability between operators, with certain individuals exhibiting higher mismatch rates, although no CMM was linked to specific operators.
4. Staffing and Workflow: Extended working hours after 4 pm and insufficient staffing were identified as risk factors for CMM, underscoring the importance of managing staff workload and reducing fatigue.
5. Recommendations: The study suggests improvements in workflow, such as assigning specific tasks to dedicated stations and reducing multitasking, particularly in high-risk procedures like oocyte denudation and embryo transfer.

Key Points:

• Mismatch and CMM Risk Factors: Specific laboratory processes (e.g., oocyte denudation, embryo transfer) and staffing issues (e.g., extended hours) are significant contributors to mismatches and CMM.
• Operator Influence: While individual operators may affect mismatch rates, this did not extend to CMMs.
• Workflow Optimization: Redesigning laboratory workflows and improving staff management (e.g., avoiding overtime fatigue) could reduce errors.
• EWS Utilization: While EWS can prevent mix-ups, additional measures like double witnessing and proper operator training are crucial.

Prevention Strategies for IVF Laboratory Mistakes:

• Ensure sufficient staffing during peak hours, especially post-4 pm, to reduce operator fatigue.
• Implement double witnessing at critical steps, such as embryo transfer and oocyte denudation, and use EWS for constant monitoring.
• Avoid multitasking, particularly for operators involved in high-risk processes, by assigning dedicated roles for critical laboratory tasks.
• Establish protocols for managing the workflow, such as separate workstations for specific tasks like oocyte denudation, and ensure all equipment is cleared of previous patient materials.