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Best Practices for Newborn Hearing Screening and Follow Up

Read the EHDI Best Practices for Newborn Hearing Screening and Follow Up:

 

 

EHDI Best Practices for Newborn Hearing Screening and Follow Up

Robert Cicco, MD

EPIC-EHDI Program of PA Chapter, American Academy of Pediatrics

 

1.  Have a designated hospital EHDI coordinator

Having a coordinator in place that is responsible for tracking positive screens, assuring reports are sent to the Department of Health (DOH) and coordinating screens from both the Mother-Baby Unit/Newborn Nursery and NICU minimizes the number of possible errors in tracking, follow up and reporting. This position should have clear roles and responsibilities defined. If more than one individual is involved in this role, it should be clear who has responsibility for:

  • Coordinating screens from the Mother-Baby Unit/Newborn Nursery and NICU
  • Assuring information gets to the primary care physician (PCP)
  • Sending aggregate and individual reports to DOH
  • Scheduling follow for babies who do not pass the hearing screen
  • Training and supervising staff who perform hearing screenings
  • Ensuring maintenance and updating of hearing screening equipment

                   2.  Limit the number of hearing screenings given to a newborn to achieve the most accurate result.

  • Multiple screenings (greater than two times) during one session using the same technology are not recommended in order to avoid getting a false ‘pass’ result.
  • If a newborn does not pass the screening, it is acceptable to repeat the screening one time during the same session using the same technology, assuming the recording conditions are optimal (i.e., timing, noise conditions, or state of the newborn).
  • Screenings should be limited to two sessions per newborn. 
  • Screening results at individual frequencies should never be combined across screening sessions in order to obtain a ‘pass’ result.

3.  Provide clear, supportive and easy to understand information to parents

It is important to provide parents with information on newborn hearing screening and the results of their baby’s hearing screening in a clear, supportive and easy to understand manner. The information should:

  • Educate parents about:
  1. The importance of hearing in babies and children
  2. The critical nature of identifying hearing loss in babies and children as soon as possible to ensure the best outcomes
  3. The need to talk to the baby’s PCP if there are any concerns with hearing in the future.
  • Be consistent. (Training staff on how to talk to parents and providing printed materials on hearing screening for parents to take home is important to achieving a consistent message).
  • Emphasize the importance of prompt follow up for babies who did not pass their hearing screening without minimizing the potential problem. Encourage parents by emphasizing that early identification leads to better outcomes.
  • Instruct parents on how/where to obtain follow up if their baby did not pass the hearing screening (ideally an appointment for follow up or contact information for parents to make an appointment).

Here are sample scripts for use by hospital screeners that were developed by the National Center for Hearing Assessment and Management (NCHAM). These scripts provide a balanced way of informing parents of their baby’s hearing screening results and can be adapted for use at your hospital.

Script for parents of newborn who passed the hearing screening:

http://www.infanthearing.org/infant_screening_course/page964.html

Script for parents of newborn who did not pass the hearing screening:

http://www.infanthearing.org/infant_screening_course/page976.html

4.  Link babies to follow-up prior to hospital discharge

Linking babies that do not pass their hearing screening to outpatient follow up prior to hospital discharge will minimize the number of babies lost to follow up. It is preferable to have a formal relationship with an audiology center but obviously this is not always possible. However, knowing the centers to which a baby will be referred and giving parents information and/or making an appointment for them greatly increases the chances the family will follow up.

5.  Identify and communicate with the baby’s PCP (primary care physician) prior to discharge

It is critical for a number of reasons to correctly identify the baby’s PCP prior to hospital discharge and have a mechanism in place to send to that PCP a complete summary of the newborn stay, including the results of the hearing screen. It is not enough to only send the PCP screening results if they are positive. All babies should have all results sent to their PCP in a timely fashion, preferably within 48 hours when most babies will be seen for the first time after hospital discharge.

6.  Identify high risk conditions in addition to screening

Currently, there is not a system to report babies to DOH who pass the newborn screen but have risk conditions for progressive hearing loss or late-onset hearing loss. Therefore, identifying these babies and assuring that this information is communicated to the PCP will increase the chances that these babies will be tracked appropriately and diagnosed more readily if hearing loss should occur.

For more information on risk factors/conditions:  http://www.paearlyhearing.org/birth-facilities/item/189-what-are-the-risk-factors-for-late-onset-and-early-childhood-hearing-loss 

7.  Assure that correct information is sent to DOH

In addition to communication with the PCP, the EHDI system requires that accurate and complete information is sent to DOH regarding the number of babies screened, the number that did not pass the screen and individual information on those babies that either did not pass the hospital screen or do not return for a rescreen. It is vital that the data is accurate, including family demographics, the baby’s last name after discharge, the correct PCP and alternate contact information. The reason this information is so important is that DOH tries to find and follow all babies from individual referral forms to assure that they receive appropriate follow up. This cannot occur if inaccurate and\or incomplete information is sent to DOH on the referral form.

Finally, the number of individual referrals sent to DOH should regularly be reviewed to determine if this number is consistent with the monthly aggregate data reported. Obviously, assuring correct information is being sent to DOH can best occur if this task is given to as few people as possible, preferably a hospital EHDI coordinator as outlined in #1 above.

View the complete Newborn Hearing Screening Guidelines for Pennsylvania: http://www.paearlyhearing.org/images/attachments/PA_Newborn_Hearing_Screening_Guidelines_-_March_2013.pdf

8.  Consider making follow up phone calls to parents 24-48 hours after discharge

Making a follow up phone call to parents 24-48 hours after discharge is an important opportunity to:

  • Reinforce information provided during the hospital stay.
  • Remind families to tell their PCP if they ever have any concerns about their baby’s hearing.
  • Identify any high risk conditions for hearing loss that may not have been identified during the hospital stay.
  • Allow parents to ask any questions that may have arisen since discharge.
  • Remind parents of any follow up appointments, if needed (such as to an audiology center for a “not pass” hearing screen).

9.  Track the number of no-shows if outpatient rescreens are done

If outpatient rescreening is done at your institution, it is important to keep track of the number of no-shows for follow up. This is the only way of knowing how many babies with “not pass” screens in the Mother-Baby Unit/Newborn Nursery are being lost to follow up. If this number is excessively high, steps can then be taken to correct this problem. This may involve sending out reminder cards, making phone contact or other methods. If the return rate cannot be increased, after an effort is made to do so, consideration should be given to referring those babies who did not pass the hospital screen directly to an audiology center for evaluation. 

10.  Make hearing screening part of hospital QI activities

Improving the quality of newborn hearing screening can be accomplished in a number of ways:

  • Provide formal training for any new staff that will be involved in screening babies
  • Make the performance of screening part of annual competencies
  • Work with an audiology center to assist in training staff
  • The number of babies screened
  • The percentage of babies who did not pass the screen
  • The number of parents who decline to have their baby screened

In addition to setting quality standards for the actual performance of an OAE or aABR, quality measures can also be established for insuring that families are given appropriate information stressing the importance of follow up for babies who do not pass and the need for families to seek care if they have any concerns about hearing even if the baby passes. Finally, hospitals can create quality standards for:

Monthly aggregate reports can be evaluated against these standards to assess the quality of screening and referral.

11.  Engage your medical staff

Engagement of staff physicians in quality initiatives and communicating results of hearing screening to parents will reduce any mixed messages they receive regarding the importance of follow up.

Additional information and resources on newborn hearing screening and early hearing detection and intervention can be found on the PA EHDI website:

http://www.paearlyhearing.org/birth-facilities

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