Study improves patient care and provider collaboration

Teamwork triples success rate of removing troublesome device

If you think about it, a lot of what cardiologists do involves putting things in – such as stents, pacemakers or a device to prevent strokes. But sometimes, the best thing for the patient is to take a device out.

That’s the case with a clot-blocking filter that’s placed in the inferior vena cava – a large vein that delivers blood to the heart from the lower half of the body.

The spidery, cone-shaped cage traps dangerous clots that might otherwise go to the lungs. It’s inserted using a catheter and is a life-saving alternative for patients who can’t take blood thinners. But over time, the device can cause complications.

This experience deepened our relationships with colleagues, which benefits all of our patients.

Mary Cushman, MD

“Most of the time, the filters are only needed for a little while, so it’s often better to take them out, because there’s a risk of them dislodging, filling up with clots, or puncturing the vein,” says Mary Cushman, MD, director of the Thrombosis and Hemostasis Program at The University of Vermont Medical Center. “Unfortunately, the logistics of removing them can be difficult, and about 10 years ago we realized only about 23 percent were being taken out.”

Seeking to improve that rate, Cushman, who is also a professor of Medicine at the Robert Larner, M.D. College of Medicine, helped launch a study with colleagues from Interventional Radiology, Trauma Surgery, Nursing, the Research Office and her own clinic to identify and test changes the team thought might work.

“Our focus was on improving coordination and communication with the patients and each other, and carefully evaluating the need for retrieval,” said Chris Morris, MD, an interventional radiologist and professor.

The results were so good – a tripling of the success rate – that the study was accepted for publication this past year in Vascular Medicine, a premier international journal in the field.

“We’re excited about being published because it will help spread the word about how a team approach to problem-solving can have a really positive impact on patient care,” said William Charash, MD, division chief of Trauma, Burn and Critical Care Surgery and an associate professor.

“This experience deepened our relationships with colleagues, which benefits all of our patients,” said Cushman. “We appreciate each other more now, and it’s easier for us to collaborate.”