Newborn children hearing assessment - Royal Berkshire NHS Foundation Trust

DIFFUSION

WHAT IS THE ISSUE?

Permanent hearing impairment affects 3 in 1,000 children. Newborn hearing screening is overwhelming carried out in hospitals using specialised staff where coverage can be low and false positive rates high with high costs.  The early detection, diagnosis and habilitation of hearing impairment in children is crucial to outcomes in terms of educational attainment, speech development and cognitive development.

The National Quality Assurance Programme has shown diagnostic testing after screen fail to be of poor quality across the UK. Fifty percent of babies offered testing in hospital may not attend their appointments. Parents of babies who do attend find this a stressful, anxious appointment, normally attended by only one parent.  This project aims to address the shortcomings of the current practises via diffusion of innovative techniques.

WHAT IS THE INNOVATION?

The Royal Berkshire NHS Foundation Trust team have developed a model where newborn hearing screening is carried out at home by Health Visitors with a coverage of > 99.6% and low referral rate of < 1%. In the home, babies and parents are relaxed and less stressed allowing highly accurate results to be obtained very close to birth from 100% of babies with hearing impairment. It may be easier for both parents to be present, reducing anxiety and allowing movement towards rehabilitation. Because appointments are in own homes, parents are more receptive to informational counselling and habilitation can proceed immediately. This is a multi-disciplinary, family focused service in partnership with voluntary and educational services, social services and other clinicians. It is very highly regarded by parents and other professionals. The RBFT team aim to diffuse these techniques to clinical colleagues across South Central SHA with the objective that each baby born with a hearing impairment should have equal speech and language development, educational attainment and economic and social success as their normally hearing peers. The project requires diffusion of academic and clinical training to clinicians in their own geographical locations.

WHAT IS THE BENEFIT?

For patients/staff/service

• Improved skills for audiology clinicians in the assessment and rehabilitation of young babies.
• Staff can work flexible hours to fit in around their own child care needs.
• Patients will have speech and language development, educational attainment, economic and social participation equal to hearing peers.
• Parents will experience reduced anxiety, less disruption to family life from attending appointments, car parking, arranging childcare, empowering fathers to be present at diagnosis and involvement in defining services; high satisfaction with service received; and good outcomes for their children.
• Social value – reduction in costs to councils in educational and social services and benefit to society from enabling hearing impaired adults to play a full role.

Increased quality and productivity

• Reduction in audiology, ENT and speech and language therapy appointments.
• Reduction in accommodation costs – sound proof rooms.
• Earlier diagnosis and treatment – mean age hearing aid fitted 1-6 months (previously 9-18 months).

Spread and sustainability

• Diffusion of techniques to clinical colleagues across South Central SHA by RBFT team.
• Diffusion of lean methodology to reduce DNA rates from 50% to 0%. Only a single test appointment is necessary, rather than several.  Parental anxiety is reduced.  Parents don’t have to take time off work.
• Pressure is reduced on test equipment (£30K each), hospital accommodation and other staffing costs.

Projected savings

• Estimated reduction in outpatient appointments: 200 per site per year across 5 sites with 1,000 appointments @ £75 each equalling £75,000 per annum.