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American Academy of Pediatrics
Quality Report

Identifying Quality Improvement Opportunities in a Universal Newborn Hearing Screening Program

Kenneth C. Deem, Ernesto A. Diaz-Ordaz and Brian Shiner
Pediatrics January 2012, 129 (1) e157-e164; DOI: https://doi.org/10.1542/peds.2011-0912
Kenneth C. Deem
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Ernesto A. Diaz-Ordaz
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Brian Shiner
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Abstract

Background And Objectives: Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality assurance protocols, but many hospitals lack the time and resources to initiate this process. We studied a practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs.

Methods: We determined screening processes and quality indicators for UNHS programs at 4 hospitals through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. The sessions identified improvement opportunities and proposed system changes for immediate implementation.

Results: Hospitals screened 21 957 newborns for hearing loss. Screening rates were >99% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also increased referrals to Early Intervention Child Find services on the basis of our finding that these referrals increased the likelihood of diagnostic follow-up fourfold. We could not fully assess indicators of hearing aid eligibility and enrollment in early intervention services due to insufficient documentation.

Conclusions: Review of nursery and audiology records successfully established most quality indicators for the UNHS programs we studied. Feedback of quality indicators identified multiple improvement opportunities and facilitated endorsement of immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.

KEY WORDS
  • neonatal screening
  • hearing loss
  • early intervention
  • health care quality, access, and evaluation
  • quality improvement
  • Abbreviations:
    AABR —
    automated auditory brainstem response
    EHDI —
    Early Hearing Detection and Intervention
    EI —
    early intervention
    JCIH —
    Joint Committee on Infant Hearing
    PCHL —
    permanent congenital hearing loss
    UNHS —
    universal newborn hearing screening
    • Accepted September 9, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 1
    1 Jan 2012
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    Identifying Quality Improvement Opportunities in a Universal Newborn Hearing Screening Program
    Kenneth C. Deem, Ernesto A. Diaz-Ordaz, Brian Shiner
    Pediatrics Jan 2012, 129 (1) e157-e164; DOI: 10.1542/peds.2011-0912

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    Identifying Quality Improvement Opportunities in a Universal Newborn Hearing Screening Program
    Kenneth C. Deem, Ernesto A. Diaz-Ordaz, Brian Shiner
    Pediatrics Jan 2012, 129 (1) e157-e164; DOI: 10.1542/peds.2011-0912
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