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The Power of a Written Result: Nevada Sees Improved Hearing Screening of Infants

August 15, 2013
By Kristina Grifantini

Infants with hearing loss benefit the sooner they enroll in early intervention (EI) services, such as learning sign language or receiving a hearing aid. Sometimes the process from the initial hearing screen at the birthing hospital, to a confirmation of diagnosis at a specialist, to enrollment in EI, doesn’t run as effectively as it should.
The national recommendation is for children to be diagnosed by 3 months of age and enrolled in early intervention services by 6 months of age to not fall behind in communication skills. The more a state can account for each child’s hearing results and status, the more effectively it can intervene if a child is not getting more timely care.
NICHQ’s Improving Hearing Screening & Intervention Systems (IHSIS) program has worked with 49 states to help each state’s public hearing screening department make improvements in these processes to help prevent developmental delays in children with hearing loss. The state of Nevada has seen significant improvements after employing several quality improvement techniques learned through the program. By the end of 2012, the number of infants whose hearing diagnoses were unknown by the state dropped down to 49 percent from 77 percent the prior year and continue to improve.
The Nevada team, made up of local audiologists, parents and staff from the state Early Hearing Detection Intervention (EHDI) office used quality improvement techniques—such as testing small tests of change, getting parent feedback and scaling up successes—to improve three particular aspects of the process.

Baby Certificates and Parent Feedback

Sometimes results and next steps for a failed hearing screen aren’t communicated effectively to parents, and the child experiences delays in getting appropriate treatment. The Nevada team helped smaller hospitals in rural areas give screening results to parents in writing. The team developed a baby certificate that would either confirm the infant had passed or not passed hearing screening, with information on follow-up rescreening or diagnostic audiology if needed.

Run chart showing how often the team sent results to a PCP using the checklist

Run chart showing how often the Nevada team sent results to a PCP using the checklist.

While this team is still gathering data on the effectiveness of handouts, it has anecdotal evidence of success. Nurses polled at the local hospitals said they thought it was helpful and something that parents like to have (one nurse reported that a family saved the hearing screening certificate in a baby book). Nurses also reported that the handout makes it easier for them to talk about hearing screening results with families.
A second change the team tested is calling families who did not have a record of follow-up after failing the hearing screening. Parents suggested that more specific next-step information—specifically the phone number of an audiologist—be included and the Nevada team has made this change. The team says family input in directing and making system changes is invaluable.
“My little guy was born deaf in 2004, when Nevada didn’t have EHDI or any of the support that exists now,” says Cindy Roller, executive director of the hearing advocacy group Nevada Hands & Voices and parent representative on the team. “I absolutely wish we had them when we were going through our diagnosis. The support now—the letters and roadmaps—gives guidance on what to do. We’ve tested lots of things and started to implement and our numbers of loss-to-follow-up are coming down.”
Roller and the team plans to create a bilingual form, which other teams have found successful in reducing loss to follow-up.
“Roller is a very key part of the team. She is a good resource herself as well as a resource for connecting us with other parents to get other feedback,” says Diane Miller, AuD, follow-up coordinator for the Nevada EHDI office.
Watch the video below to hear Roller talk more about her experience in improving hearing screening:

Another part of the process that needed improvement was communication from audiology to the primary care doctor and the family. The team introduced reminder checklists at one audiology facility, reminding audiologists to get releases signed by families for permission to forward the written hearing test results to the primary care physicians. The checklist also reminded the audiology department to send a copy of the result to the family, even if the child was confirmed to have normal hearing.

“That test was very successful in this office and has been implemented,” says Miller. “Now this change has been moved into the test phase at a second audiology clinic.”
As for the final step of the process, getting infants from the audiologist to EI services as quickly as possible, the team has also made improvements. The EHDI office has gone from having 0 percent of dates of EI enrollment of diagnosed babies to 100 percent by simply faxing each provider monthly asking for the date of entry for babies enrolled in that month. Small, effective changes like this has given EHDI representatives more timely data, allowing them to intervene if they see an infant with a hearing diagnosis who is not given a date of EI enrollment.
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