Sound Beginnings

Introduction

Closing The Follow-Up Gap: An EHDI Case Study

Inpatient Screening

Dora Garcia, the second child born to Kimberly and Carlos, was delivered at Midstate Hospital in rural Wisconsin. Dora is an 8lb 4oz baby who needed no resuscitation, has no craniofacial anomalies and has no history of hearing loss in her family. In order to accommodate Kimberly’s request to be discharged no later than 24 hours after Dora’s birth, Dora was taken to the nursery for her hearing screening while her mother slept. The result of Dora’s hearing screening was recorded in the EMR and on her blood screening card. The Sound Beginning brochure was left on the bedside table for Kimberly to read when she awoke.

Because Dora’s left ear did not pass the hearing screening, the day-shift nurse rescreened both of Dora’s ears just prior to discharging the family. Dora’s results remained consistent. This time, the nurse, along with a Spanish language interpreter, explained the results to Kimberly and Carlos and provided them with the Guide By Your Side Follow-through brochures in English and Spanish, as well as the Family Care Map, which provided a written record of Dora’s results.

On admission, a PCP for baby was not recorded on the prenatal record, which was standard. The RN assists the family in choosing a PCP for Dora by discussing a list of physicians currently seeing new patients. The RN then faxes the hearing screening results to Dr. Lowe at Badger Clinic to alert him that Dora did not pass her hearing screening. The Midstate hospital staff does not schedule an audiology appointment prior to discharge because the family wants to discuss the need for follow-up with a pediatrician, as they are concerned about insurance coverage for the additional testing.

Discussion Points

How does the care align with screening guidelines and best practices?
How is the family engaged?
How is care coordinated and communicated?
How do you find resources appropriate to this family’s needs?
What staff training is needed?
How can you help families identify PCP prior to discharge?
How can you assure that your hospital is recording PCP every abby?
How would this infant be handled if transferred to the NICU?

Improvement Strategies

Standardize the process for documenting all newborn screening results in the hospital records

Record and report the results accurately to the state EHDI program via the blood card

Standardize communications (written and verbal) with parents about newborn screening results

Verify the PCP/Medical Home before discharge

Communicate did not pass results to the PCP/Medical Home as a critical value requiring confirmation

Identify two points of contact for families of infants who did not pass (i.e. a relative or friend)

Provide clear communication about next steps using the EHDI care map

Schedule the follow-up appointment prior to discharge, stressing importance with families

Best Practices

“I was really upset when my daughter did not pass her hearing screening. The nurse said it was probably just fluid in the baby’s ears.This was comforting but could have been detrimental as I almost blew off the follow-up appointment. Luckily I went and was shocked by the news that my daughter had hearing loss in both ears.”