29 - IVC Filter Tracking

The Mayo Clinic of Arizona (MCA) Interventional Radiology (IR) Division has a goal to remove retrievable inferior vena cava (IVC) filters placed at MCA within six months if the patient is able to resume anticoagulation in the setting of venous thromboembolic event (VTE) or is medically appropriate for removal. In 2011, a systematic review of 37 studies was published including 6,834 patients which calculated the mean retrieval rate was 34%. At one month, the successful retrieval attempts were 99%, at 3 months were 94%, and at 12 months were 37% {1}.  At MCA, our purpose of this project was to improve the process of IVC filter tracking and therefore improve the successful removals of IVC filters.

Materials and Methods: For IVC filter patients, the IR physician assistants (PAs) strive to see every patient for an IR Clinic Consult within three months after retrievable IVC filter placement. Data showed that the number of days between IVC filter placement and IR Clinic Consult order varied significantly and the PAs have been manually tracking IVC filter patient information on a spreadsheet since 2017, therefore a multidisciplinary team was formed to address the problem. A Lean Six Sigma DMAIC (Define, Measure, Analyze, Improve, and Control) quality improvement methodology was used. MCA team created a dynamic worklist on Epic® (Verona, Wisconsin) utilizing implant data from patient’s charts.  The new report and workflow were implemented in May 2024. A retrospective review is in-progress including time from placement of IVC filter to time that follow up orders are placed and time to successful retrieval.

Results:

A retrospective review from Jan-Oct 2023 at MCA, showed that 24% of the IR Clinic Consult orders were placed 10 days or greater after IVC placement. The average days between IVC filter placement at MCA and follow up order entry is 7.09 days and ranged from 0 days to 28 days. From June 2024 to August 2024, we have decreased the average days between IVC filter placement and follow up order entry to 6.00 with new IVC filter tracking implementation. Additionally, at the time of presentation of this abstract, we plan to determine the average time to successful retrieval at MCA.

Conclusion:

Inferior Vena Cava (IVC) filter tracking has been difficult for many practices. Risks to prolonged retention including filter fracture, filter migration, and vena cava thrombosis or stenosis {1}. Tracking these implants successfully is imperative for timely removal, which decreases the risk of complications and increases the risk of successful retrievals.