Development of a Vena Cava Filter Retrieval Reminder: Optimizing the Removal of Inferior Vena Cava Filters

Retrievable vena cava filters (VCF) are commonly used to treat patients at risk for venous thromboembolic (e.g., deep vein thrombosis, pulmonary embolism) events where anticoagulation, the primary treatment, is contraindicated. All VCF devices are approved be a left in situ as permanent devices, however the majority of these filters are retrievable and should be removed. Retained filters may harm patients. The Food and Drug Administration (FDA) recommends that all patients that have retrievable VCFs should be medically evaluated for safe removal sooner than later. Longer VCF filter dwell times are associated with increased complications such as: filter strut fracture, filter migration/embolization, venous/arterial penetration, and thrombotic sequelae. Researchers have found that IVC filter retrieval rates are low due to loss of follow-up care, lack of dedicated filter clinics, and lack of patient tracking systems. The objectives of this project are to improve the timely removal of IVC filters at a large tertiary care hospital on Utah's Wasatch Front, improve provider knowledge of the importance of timely removal of IVC filters, and disseminate scholarly project results to a broader audience. For this scholarly project, an electronic health record (EHR) reminder tool that will alert and remind clinicians to review patients with VCFs for timely removal was developed. This electronic reminder system will alert clinicians to schedule a filter removal when the risk of pulmonary embolism has been minimized. Interventional radiologists at a large hospital were surveyed for the content of the EHR filter removal reminder application. The survey results were used to build the content of the EHR reminder and fact sheet. A ticket or work order was submitted to the electronic health record clinical support team to develop a pop-up reminder that would satisfy the project goals. Unfortunately, the pop-up reminder was rejected by a clinical support decision committee and deemed too intrusive causing alert fatigue. Alternate reminder solutions were reviewed and discussed with information technology specialists. An alternate solution was selected and is currently being developed. A fact sheet based on the results of the survey and the literature review was created to educate providers of the importance of using EHR reminders to facilitate timely removal of VCFs. Lastly, a project abstract was created and submitted to the annual CME Snowbird Conference. In conclusion, providers want a simple solution to track or remind clinicians to remove VCFs in a safe and timely fashion. Electronic health record reminder solutions are simple tools to achieve this goal. However, designing acceptable EHR reminders within a large hospital system requires input from many individuals, is complicated, and can be time consuming.