15 Year Trend in Inferior Vena Cava Filter Utilization Before and After FDA Communications: Data from the National Inpatient Sample 2005-2019.

The purpose of this study was to evaluate the contemporary trends in IVC filter utilization in the inpatient setting following the FDA safety communications and to compare those trends in relation to incidence of hospital admissions involving venous thromboembolism. The National Inpatient Sample was queried between 2005-2019. There was an increasing trend in the utilization of IVC filters between 2005-2010 (P < 0.01). Following the FDA communication in 2010, this trend reversed to a decreasing trend (P < 0.001) which persisted following the second FDA communication in 2014, though there was no significant change in the rate of decline (P = 0.67). Throughout the entirety of the study period, the proportion of IVC filters placed in patients with venous thromboembolism increased from 70.8% to 82.2%.

Utilizing a Quality Improvement Approach to improve Positioning of Acute Burn Patients.

Patient positioning, using "anti-deformity positioning," is a standard practice in burn rehabilitation to assist with edema management, scar contracture prevention, and wound healing. Consistently providing proper positioning requires the combined effort of the multidisciplinary burn team. Our primary goal was to increase the frequency that patients were correctly positioned to over 90%. At a medium-sized, academic burn unit, random audits were conducted by burn lead therapists on the compliance of proper patient positioning over six months. Using this data as a trigger, a quality improvement project was designed using the PDSA (Plan-Do-Study-Act) cycle. Surveys were distributed to therapy and nursing staff to identify barriers to proper positioning. Effects on positioning compliance post-intervention were monitored. In the six months prior to intervention, average correct positioning was 76%. Surveys identified the following barriers to care: nursing needed more education and the approach was too heavily reliant on nursing efforts alone. To address this, therapists provided education to all nurses, communicated daily about positioning expectations, shifted the project to a multidisciplinary approach, and made changes in therapy workflow. The median compliance improved from 79% to 91% (p < 0.05). Coordinating efforts of the entire burn team improves consistency for positioning in burn patients. Utilizing the PDSA cycle allowed us to identify areas for improvement and develop appropriate interventions to increase education for nursing staff and workflow improvements for therapists. Following the completion of our interventions we were able to obtain an immediate improvement in our patient positioning compliance.