Improving Inferior Vena Cava Filter Retrieval Rates with the Define, Measure, Analyze, Improve, Control Methodology

• Published in: Journal of vascular and interventional radiology Vol. 26; no. 4; pp. 491 - 498.e1
• Main Authors: Sutphin, Patrick D., MD, PhD, Reis, Stephen P., MD, McKune, Angie, RN, BSN, Ravanzo, Maria, MPAS, Kalva, Sanjeeva P., MD, Pillai, Anil K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Adult; Aged; Aged, 80 and over; Critical Pathways - standards; Device Removal - standards; Female; Humans; Male; Middle Aged; Process Assessment (Health Care) - standards; Pulmonary Embolism - prevention & control; Quality Assurance, Health Care - organization & administration; Quality Improvement - standards; Quality Indicators, Health Care - organization & administration; Radiology; Vena Cava Filters - standards; Young Adult; Plan, Do, Study, Act; FDA; relative value unit; CPT; PDSA; Current Procedural Terminology; Define, Measure, Analyze, Improve, Control; DMAIC; RVU; inferior vena cava; quality improvement; IVC; QI; Food and Drug Administration
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2014.11.030

Abstract Purpose To design a sustainable process to improve optional inferior vena cava (IVC) filter retrieval rates based on the Define, Measure, Analyze, Improve, Control (DMAIC) methodology of the Six Sigma process improvement paradigm. Materials and Methods DMAIC, an acronym for Define, Measure, Analyze, Improve, and Control, was employed to design and implement a quality improvement project to increase IVC filter retrieval rates at a tertiary academic hospital. Retrievable IVC filters were placed in 139 patients over a 2-year period. The baseline IVC filter retrieval rate (n = 51) was reviewed through a retrospective analysis, and two strategies were devised to improve the filter retrieval rate: ( a ) mailing of letters to clinicians and patients for patients who had filters placed within 8 months of implementation of the project (n = 43) and ( b ) a prospective automated scheduling of a clinic visit at 4 weeks after filter placement for all new patients (n = 45). The effectiveness of these strategies was assessed by measuring the filter retrieval rates and estimated increase in revenue to interventional radiology. Results IVC filter retrieval rates increased from a baseline of 8% to 40% with the mailing of letters and to 52% with the automated scheduling of a clinic visit 4 weeks after IVC filter placement. The estimated revenue per 100 IVC filters placed increased from $2,249 to $10,518 with the mailing of letters and to $17,022 with the automated scheduling of a clinic visit. Conclusions Using the DMAIC methodology, a simple and sustainable quality improvement intervention was devised that markedly improved IVC filter retrieval rates in eligible patients.