Improving Inferior Vena Cava Filter Retrieval Rate With the Implementation of a Registry and Nurse Navigator at a Large Academic Hospital After 4-Year Retrospective Inferior Vena Cava Filter Retrieval Chart Review

Abstract

SESSION TITLE: Venous Thromboembolism SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Utilization of inferior vena cava filters (IVCF) for venous thromboembolisms (VTE) have exponentially increased after the advent of retrievable IVCF (RIVCF) and the expansion of accepted indications of use. A RIVCF should be removed once the risk for VTE resolves or when anticoagulation therapy can be resumed. Unretrieved IVCFs may result in filter migration, fracture, embolization, caval thrombosis, and IVC perforation. However, several single-center studies demonstrated retrieval rates (RR) of only between 14 and 45%. Thus, we first set out to ascertain our retrieval rate and then implement a system to improve it. METHODS: A four-year (January 1st 2012 to July 29th 2016) retrospective chart review of the medical records of patients who underwent IVCF placement and retrieval procedures at an interventional radiology section of a large academic hospital was conducted and IVCF retrieval rate was ascertained. An IVCF registry was created while conducting the chart review. After the conclusion of the retrospective chart review, a nurse navigator was put in charge to continue to update the registry and tract for potential IVC filter retrieval. RESULTS: A total of 387 IVCFs were placed during the four-year span of the review. The mean patient age was 60.8 years and the mean filter dwell time was 812 days. The number of IVCFs removed was 24. The number of potential retrieval opportunity was 166 (42.9%). Complication rate of retrieval was 0.775%. Adjusted for patient death, loss to follow-up, and permanent indications, the adjusted IVCF RR was 12.6%. Since January of 2017, 12 patients with the registry and coordination of a nurse navigator were identified for IVCF retrieval and had them successfully removed. CONCLUSIONS: The adjusted IVCF RR of 12.6% was lower than the range of RRs (14-45%) from several other single-center retrospective studies. Most of the studies found rates closer to 20%. Such variations may be attributed to differences in hospital operations, patient populations, or the specialty performing the procedure. However, the chart review established a baseline RR and allows us to compare it to future RRs and quantity retrieval improvements with implementation of IVCF registry and a nurse navigator. Since the implementation of those two factors, 12 IVCF were removed compared to 24 IVCF that were removed in the last 4 years without the two factors. Thus, a total of 12 patients, who otherwise most likely would have unnecessarily kept their IVCFs, benefitted from its retrieval and have their potential complications removed. CLINICAL IMPLICATIONS: Patient follow-up care is one of the most neglected part of healthcare improvement efforts which may stem from the fact that the medical reimbursement in most cases are not linked to patient’s health outcome after leaving the hospital. Nevertheless, striving to continue to make improvements in post-treatment patient care is vital for any medical field. As the median age of our patient population and the use of RIVCF continues to increase and retrieval of RIVCF remain low, we are wary of possible large influx of indwelling IVCF complications. To minimize this risk and prevent adverse health outcomes of our patients, we find value in making this improvement. DISCLOSURE: The following authors have nothing to disclose: Daniel Lee, Hanzhou Li, Hoang-Anh Vo, Ana Rita No Product/Research Disclosure Information