Strategies associated with high inferior vena cava filter retrieval: a positive deviance study

Area of Science:

• Medical Devices
• Vascular Surgery
• Health Services Research

Background:

• Inferior vena cava (IVC) filters are crucial for preventing pulmonary embolism.
• Timely IVC filter retrieval is recommended after mechanical protection is no longer needed.
• Current retrieval rates in the US are low, with significant interfacility variation.

Purpose of the Study:

• To identify barriers to timely IVC filter retrieval.
• To describe surveillance processes and implementation strategies in high-retrieval hospitals.
• To understand factors contributing to exceptionally high IVC filter retrieval rates (>95th percentile).

Main Methods:

• Qualitative analysis embedded within a mixed-methods positive deviance study.
• Examined 4 high-performing and 3 intermediate-performing US hospitals based on risk-adjusted retrieval rates.
• Analyzed semistructured interviews with surveillance personnel using rapid qualitative analysis.

Main Results:

• Common barriers included reliance on individual clinicians, labor-intensive tracking, and communication challenges.
• High-retrieval hospitals utilized empowered non-physician champions and protocolized surveillance.
• Presumptive communication and risk-stratified evaluations were key strategies, with EMR dashboards showing limited differentiation.

Conclusions:

• High IVC filter retrieval success depends on operationalizing follow-up into routine care.
• Scalable interventions should focus on non-physician ownership, risk-stratified escalation, and streamlined decision-making.
• Registries and dashboards alone are insufficient without effective program implementation.