Informatics approach improves workflow, patient care in IVC filter

Patients with retrievable inferior vena cava (IVC) filters used to prevent venous thromboembolisms face increased complication risks the longer their device remains without being extracted.

To address that issue, Memorial Sloan Kettering Cancer Center researchers in New York designed a semiautomated informatics approach that improved care coordination and patient care. Their research was published in the American Journal of Roentgenology.

“Our tracking system was able to improve clinic visit scheduling workflows, achieving increased efficiency by avoiding unnecessary visits and enhancing the value of patient discussions by focusing on patients for whom changes in filter management plans were considered appropriate,” wrote corresponding author Krishna Juluru, with Sloan Kettering’s department of radiology and colleagues.

In 2014, the FDA announced providers responsible for continuous care of IVC patients should remove the filter as soon as the threat of pulmonary embolism was eradicated. In response, some institutions have created IVC filter clinics, but authors found the approach could leave clinical management unchanged.

Juluru and colleagues created a filter-tracking application to search the radiology department’s information system and transfer key data points related to IVC filter insertion procedures into a central database. A web interface showed the information and promoted communication between the interventional radiology (IR) clinical team and referring physicians. 

The team used retrospective observational cohort methods to compare filter retrieval rates from July to December 2016. They tracked 293 IVC filter placements and 83 filter retrievals.

According to the results, the overall filter retrieval rate was 23 percent in the control group and 34 percent over the test period. The mean times for filter replacement and retrieval between the control group and test cohort were similar (88.9 days and 102.7 days, respectively).

“During the test period, the application reliably and consistently tracked all IVC filter placements within our institution, facilitated communication between the interventional radiology (IR) service and referring physicians, and was associated with a trend toward increased filter retrieval rates over a short-term evaluation period,” Juluru et al. wrote.

The results also supported a previous study led by Juluru that demonstrated low-cost components could be used to create a clinically relevant tool for a large academic center. Sloan Kettering’s radiology informatics team built the platform in 100 hours. Authors used the “industry rate” of $100 per hour to determine their tool could be created for $10,000.