Early Hearing Detection and Intervention: Timely Diagnosis, Timely Management

Objective: A quality improvement study was completed to assess the impact of three clinical practice changes on the timing of diagnosis and intervention for congenital hearing loss. Design: A retrospective chart review was conducted for 800 infants evaluated for congenital hearing loss before and after implementing three clinical practice changes: the use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expediting scheduling of initial assessment. The impact of middle ear involvement on age at diagnosis and history of neonatal intensive care unit stay on age at treatment was also examined. Results: The use of Kalman-weighted signal averaging for auditory brainstem response testing, a tone burst-prioritized testing protocol, and expedited scheduling of initial assessment each resulted in a decrease of age at diagnosis. Ultimately, the age at initial assessment was the only significant predictor related to decreased timeline for diagnosis. Middle ear pathology significantly increased age at diagnosis, while history of time in the neonatal intensive care unit significantly increased the age at provision of amplification as a treatment for permanent hearing loss. Conclusions: The technology used for assessment, clinical protocol, and timing of assessment of infants can impact the timeline for diagnosis and treatment of congenital hearing impairment. Given the significant sequelae of delayed or missed diagnosis of hearing loss in infancy, implementing clinical practice changes should be considered at pediatric diagnostic centers. ACKNOWLEDGMENTS: U. M. F. designed the study, collected and analyzed the data, and wrote the paper; G. M. H. implemented the three clinical practice changes and provided critical revision; E. A. provided statistical analysis and critical revision; O. F. A. helped design the clinical protocol changes and provided critical revision. The authors would like to thank Meghan Springer for her dedicated work on data collection as well as all of the staff in The Hearing Program at Nationwide Children’s Hospital who contributed to improving outcomes for our infants as a part of this process. Additionally, the authors would like to thank the Business Process Improvement Department at Nationwide Children’s Hospital and, specifically, the Operational Excellence program for their support during the implementation of access initiatives contributing to the results of this study. Lastly, the authors would like to thank Drs. Shuman He and Melody Davis for their thoughtful critique and input for the revision of this manuscript. Portions of this manuscript were presented at AudiologyNOW! 2017 in Indianapolis, IN and as a part of a 3-day hands-on workshop sponsored by National Center for Hearing Assessment and Management (NCHAM) and hosted by Cincinnati Children’s Hospital in June 2017 entitled “Diagnostic Protocols for Diagnostic Audiological Assessment Follow-up to Newborn Hearing Screening.” The authors have no conflicts of interest to disclose. Address for correspondence: Ursula M. Findlen, Nationwide Children’s Hospital, 700 Children’s Drive, Suite T3D, Columbus, OH 43205, USA. E-mail: ursula.findlen@nationwidechildrens.org Received October 27, 2017; accepted June 19, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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