1108. Impact of a Care Process Model on Management of Cardiovascular Implantable Electronic Device Infections
Session: Poster Abstract Session: Clinical Infectious Diseases: Bacteremia and Endocarditis
Friday, October 28, 2016
Room: Poster Hall
Background: Rates of cardiovascular implantable electronic device (CIED) implantation and CIED infections (CIEDI) have risen in the past decade. In 2003, the American Heart Association (AHA) issued guidance for CIEDI management to improve patient outcomes, such as hospital length of stay (LOS). However, in a prior study of 189 CIEDI cases at our institution from 1991 to 2010, we did not find such changes. To improve the quality of CIEDI management, an online Care Process Model (CPM) was published in 2/2012, which included an algorithm accessible at the point-of-care to aid clinical decision-making.

Methods: This is a retrospective review of patients identified from an existing CIEDI institutional database. Provider usage of the CPM was monitored and associated with the corresponding patient based on clinical documentation. We compared CIEDI patients in 3 groups: those hospitalized prior to CPM availability in 2012 (“pre-CPM”), those hospitalized after 2012 but with no documented CPM usage (“post-non-CPM”), and those with CPM usage (“post-CPM”). Variables included hospital and intensive care unit (ICU) LOS; mortality; duration of antibiotics and temporary pacemaker use; and times to consultation of specialty services, CIED extraction, pocket closure, and new CIED implantation. Chi-square analysis was used for categorical variables, and the Kruskal-Wallis test for continuous variables.

Results: There were 210 pre-CPM cases, 46 post-non-CPM, and 54 post-CPM. Cohorts were similar in age, gender, ethnicity, and CIED type. The post-CPM cohort had a statistically significant decrease (p=0.0001) in time to pocket closure (median 3.5 days) after extraction as compared to pre-CPM (5.0 days). No other significant outcomes were found. Median hospital LOS ranged from 11-14 days, and inpatient mortality ranged from 7.1%-8.0%.

Conclusion: The availability of a CPM was associated with the favorable outcome of reduced time to pocket closure after CIED extraction. However, other factors, such as hospitalization costs and mortality, were not affected. The findings from this initial investigation suggest that a prospective analysis that includes an expectation of CPM compliance is reasonable.

Eugene Tan, MD1, Avish Nagpal, MD2, Daniel C. Desimone, MD3, Brenda Anderson, RN4, Jane Linderbaum, APRN, CNP4, Thomas De Ziel, RN4, Zhuo Li, MS5, Muhammad R. Sohail, MD, FIDSA6, Yong-Mei Cha, M.D.4, Erica Loomis, MD4, Raul Espinosa, MD4, Paul a. Friedman, MD7, Kevin Greason, MD4, Henry Schiller, MD4, Abinash Virk, MD, FIDSA8, Walter R. Wilson, MD, FIDSA9, James Steckelberg, MD, FIDSA10 and Larry M. Baddour, MD, FIDSA11, (1)Internal Medicine, Mayo Clinic, Rochester, MN, (2)Sanford Broadway Medical Building, Fargo, ND, (3)Infectious Disease, Mayo Clinic, College of Medicine, Rochester, MN, (4)Mayo Clinic, Rochester, MN, (5)Mayo Clinic, Jacksonville, FL, (6)200 First Street SW, Mayo School of Graduate Medical Education, Rochester, MN, (7)Cardiovascular Diseases, Mayo Clinic, Rochester, MN, (8)Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (9)Infectious Diseases, Mayo School of Graduate Medical Education, Rochester, MN, (10)Division of Infectious Diseases, Mayo Clinic, Rochester, MN, (11)Infectious Diseases, Mayo Clinic, Rochester, MN

Disclosures:

E. Tan, None

A. Nagpal, None

D. C. Desimone, None

B. Anderson, None

J. Linderbaum, None

T. De Ziel, None

Z. Li, None

M. R. Sohail, Medtronic: Consultant , Consulting fee and Research support
Spectranetics: Consultant , Consulting fee
Boston Scientific: Consultant , Consulting fee

Y. M. Cha, None

E. Loomis, None

R. Espinosa, None

P. A. Friedman, None

K. Greason, None

H. Schiller, None

A. Virk, None

W. R. Wilson, None

J. Steckelberg, None

L. M. Baddour, UpToDate: Consultant , Licensing agreement or royalty
Massachusetts Medical Society: NEJM Journal Watch Infectious Diseases – Editor-in-Chief , Editor-in-Chief duties

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