Introduction
Closing the Follow-Up Gap: An EHDI Case Study
Determining the Diagnosis
Today baby Bernice was brought into the Trinity Audiology Clinic for a diagnostic evaluation. She is four months old. Records indicate that she has not passed either the inpatient or outpatient OAE hearing screenings in either ear. Baby is fussy when they arrive and mom reports that Bernice has a little cold today.
The mother has read the Parent Preparation instructions that were mailed to her with the appointment reminder car, so Bernice is hungry and tired. The audiologist places the electrodes prepares the baby and attempts to get her to sleep. Baby settles easily and the ABR is conducted. Threshold search indicates a moderate hearing loss bilaterally. However, when the audiologist attempts to perform a wave V threshold search with bone conducted click stimuli, the baby awakes and mom is unable to get her settled back to sleep. The audiologist is unable to perform OAEs or tympanometry to rule out middle ear involvement.
The audiologist informs the mother that there is evidence of a hearing loss but that the results are inconclusive at this time. She is provided with a copy of the Babies & Hearing Loss Notebook and instructed to make a follow-up appointment for 3 months from today for repeat testing. The audiologist dictates notes for the chart and instructs a copy to be mailed to the child’s medical home. Since the configuration of the hearing loss has not yet been determined, the audiologist does not enter information into WE-TRAC and does not make a referral to the Guide By Your Side Program or the Birth to 3 Program, but makes note to do so at the next appointment should the hearing loss be confirmed.
Register as a Pediatric Audiologist in EHDI PALS
The EHDI-PALS directory has information about pediatric audiology services for children from birth to age five. All of the facilities in this directory report that they have the equipment and expertise to serve children and have licensed audiologists. The directory contains clinic information, including:
- audiology (hearing) services
- languages available
- payment options
- appointment availability
To assure that families and providers are aware of the pediatric audiology services available at your clinic be sure to register for the EHDI PALS directory by visiting:
Prioritize newborn diagnostic exams; create expedited slots and schedule two appointments at a time
Remind families of appointments one day in advance
Provide families with instructions for a successful evaluation
Verify the PCP/Medical Home
Identify two points of contact for families of infants who did not pass such as a relative or friend
Provide clear communication about next steps using the EHDI Care Map
Identify every failed appointment as an opportunity to act and learn
Refer to early intervention (Birth to 3) within 48 hours of diagnosis
Best Practices
Policies and Procedures
- Joint Committee on Infant Hearing-2007 Position Statement
- ASHA Guidelines for the Audiologic Assessment of Children From Birth to 5 Years of Age
- ASHA Guidelines for Audiologists Providing Informational and Adjustment Counseling to Families of Infants and Young Children With Hearing Loss Birth to 5 Years of Age
- Unilateral Hearing Loss: Best Practice Guidelines for Providers
WE-TRAC
Tools for Improvement
“The audiologist that day was new to screening infants and didn’t know what to do with the crushed mom seated in front of her. She appeared very uncomfortable and busied herself with paperwork scheduling Jordan to see an ENT. Jordan’s diagnosis would have been much less painful had this audiologist been given the benefit of some counseling classes to augment her clinical skills.”
-Mother of a child with hearing loss
Training Opportunities
American Academy of Audiology CEUs are available for this course (.8 CEUs). There is no charge.
Improvement In Action
Increasing Early Identification: The benefit of scheduling two appointments (01:17)
An interview with Cindy Grant-See (text version).