title: Creating a standardized process to offer the standard of care: continuous process improvement methodology is associated with increased rates of sperm cryopreservation among adolescent and young adult males with cancer.
abstract: BACKGROUND
  There is limited literature on strategies to overcome the barriers to sperm banking among adolescent and young adult (AYA) males with cancer. By standardizing our process for offering sperm banking to AYA males before cancer treatment, we aimed to improve rates of sperm banking at our institution.
  
  
  METHODS
  Continuous process improvement is a technique that has recently been applied to improve health care delivery. We used continuous process improvement methodologies to create a standard process for fertility preservation for AYA males with cancer at our institution. We compared rates of sperm banking before and after standardization.
  
  
  RESULTS
  In the 12-month period after implementation of a standardized process, 90% of patients were offered sperm banking. We demonstrated an 8-fold increase in the proportion of AYA males' sperm banking, and a 5-fold increase in the rate of sperm banking at our institution.
  
  
  CONCLUSIONS
  Implementation of a standardized process for sperm banking for AYA males with cancer was associated with increased rates of sperm banking at our institution. This study supports the role of standardized health care in decreasing barriers to sperm banking.
authors.affiliation: Department of Urology, Division of Pediatric Urology, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, WA, USA. margarett.shnorhavorian@seattlechildrens.org
authors.forename: Margarett
authors.initials: M
authors.lastname: Shnorhavorian
authors.forename: Leah
authors.initials: L
authors.lastname: Kroon
authors.forename: Howard
authors.initials: H
authors.lastname: Jeffries
authors.forename: Rebecca
authors.initials: R
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects; D001291:Attitude of Health Personnel; D002648:Child; D015925:Cryopreservation / Q000706:statistics & numerical data; D004542:Ejaculation; D059247:Fertility Preservation / Q000523:psychology / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007248:Infertility, Male / Q000139:chemically induced / Q000209:etiology; D007258:Informed Consent; D008297:Male; D009919:Orchiectomy / Q000009:adverse effects; D010353:Patient Education as Topic; D017064:Process Assessment, Health Care; D058996:Quality Improvement; D011878:Radiotherapy / Q000009:adverse effects; D012662:Semen Preservation / Q000706:statistics & numerical data; D013074:Sperm Banks; D013118:Spinal Cord Diseases / Q000150:complications / Q000503:physiopathology; D059039:Standard of Care; D014861:Washington; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents