Abstract 16612: The Feasibility, Safety, and Value of a Virtual Cardiac Implantable Electronic Device Wound Check

Introduction: In-person wound checks are standard of care for patients implanted with cardiac implantable electronic devices (CIEDs), which include pacemakers and implantable cardioverter-defibrillators. However, in-person wound checks burden patients, providers, and health systems. A virtual wound check may be a safe alternative, but the feasibility, safety, and costing savings of a virtual CIED wound check are unknown. Methods: We performed a single-center pilot study of a virtual wound check following CIED implantation. Eligible patients included those implanted with a CIED and scheduled for an in-person wound check at our center, and who had a smartphone or digital camera and internet access. Virtual wound checks consisted of 1) patients taking and uploading a digital photograph of their wound, and 2) a phone conversation with a CIED nurse regarding signs and symptoms of wound complication. The safety of a virtual wound check as compared to an in-person wound check was assessed by examining the agreement between virtual and in-person wound checks regarding wound abnormalities detected and recommended treatments. The value of a virtual wound check was assessed with time-driven activity-based costing (TDABC), a micro-costing approach in which time is assigned to each task in both the virtual and in-person wound checks. Results: We enrolled 67 of 76 (88.2%) eligible patients, of whom 50 (74.6%) completed a virtual wound check. No abnormality was seen in either virtual or in-person checks for 42 (62.7%) patients. An abnormality was seen in the virtual but not in-person wound check in 5 patients, and in the in-person but not virtual wound check in 5 patients. Pocket swelling was detected in 6 patients during virtual wound checks, and 7 during in-person wound checks. Erythema was detected in 1 patient during an in-person wound check that was not detected during a virtual wound check. The overall agreement was 71.4%. All complications that led to a clinical action (i.e. prescription of antimicrobial drugs, placement of pressure dressing) were detected in both the virtual and in-person wound checks. TDABC analysis demonstrated virtual visits used an average of 5 minutes less of provider time, and a total cost savings of $153. Conclusions: A virtual CIED wound check is feasible, safe, and associated with cost-savings to health systems. Further work is needed to improve the processes of care for virtual CIED wound checks.