Promoting Best Practices in Assisted Human Reproduction.

Area of Science:

• Medical Law
• Reproductive Medicine
• Patient Safety

Background:

• Assisted human reproduction (AHR) involves complex clinical and laboratory processes with inherent risks.
• Regulation of the Canadian fertility industry is fragmented across federal and provincial/territorial jurisdictions.
• This fragmentation can lead to oversight challenges in AHR care.

Purpose of the Study:

• To identify factors contributing to medico-legal risks for Canadian physicians providing AHR services.
• To analyze medico-legal data from the Canadian Medical Protective Association (CMPA).

Main Methods:

• Retrospective analysis of CMPA medico-legal data from closed cases (2015-2019).
• Involved experienced CMPA medical analysts reviewing de-identified case information.
• Applied a medical coding methodology and the CMPA Contributing Factor Framework.

Main Results:

• Of 860 gynaecology cases, 43 involved AHR patients; 29 had unfavorable physician outcomes.
• Diagnostic error was noted in 10 AHR cases, often linked to decision-making and communication.
• Breakdown in communication was the most frequent patient allegation; peer experts found issues in 34 cases.

Conclusions:

• Diagnostic error is a significant clinical concern in AHR, stemming from decision-making and communication deficits.
• Enhanced clinical decision-making, situational awareness, and improved communication are crucial.
• These improvements may reduce medico-legal complaints and enhance patient safety in assisted reproduction.