LM403 - Expanding Pediatric Audiology Care into the Inpatient Hospital Setting

Abstract:
Infants who have a NICU stay of greater than or equal to five days are at higher risk for elevated hearing thresholds. In a pediatric hospital setting, it is important for audiologists to understand this increased risk for hearing loss and work with other professionals to manage hearing evaluations to provide early identification of hearing loss in this population. Multi-disciplinary collaboration is also important in other inpatient departments within the hospital, including Infectious Disease, Oncology/Hematology, and Trauma. Consideration for inpatient audiology services is important to providing best patient care, and will help expand existing audiologic services.

Summary:
At our pediatric hospital, over the past five years, we have been able to expand our audiologic services with the creation and growth of an inpatient audiology team through strategic planning. This began when several audiologists within the organization recognized an opportunity to reach an unexplored patient population and improve best patient care in the process. While the inpatient team began as a targeted effort to provide excellent audiologic care in the Neonatal Intensive Care Unit (NICU) due to the prevalence of hearing loss in the NICU population, our services have expanded and evolved over time to include oncology assessments, diagnostic testing for those with infectious disease and/or cardiac disease that may put them at risk for hearing loss, and testing for patients with a history of head trauma. Our inpatient team has created testing protocols, worked closely with Otolaryngology to coordinate ear exams at bedside and under anesthesia, and developed a relationship with our NICU Follow Up Clinic. In addition to using evidence based practice to guide clinical testing, our team has learned new techniques, patterns, and methods for evaluating medically complex patients. These efforts have led to earlier identification of hearing loss and subsequent intervention for children with hearing loss, particularly for those with multiple health needs. Adapted methods for hearing aid fittings in the inpatient setting have been set by our team through the creation of hearing aid orientation guides for nursing staff, modified bone anchored softbands, and implementation of mobile programming software where needed. Our inpatient program has also led to growth in our outpatient volumes and an overall increase in department revenue. The past four years have also taught us how to function as members of a care team for medically complex patients and has allowed us to provide education to providers regarding hearing healthcare. Several case studies offer examples of how early and thorough audiologic care contribute to improved outcomes and identification of late onset hearing loss through high risk audiologic monitoring once an inpatient is discharged. Enhanced follow up in the inpatient setting has allowed our audiology team to identify patients who may be at risk for being loss to follow up due to various socio-personal factors and has allowed for diagnostic testing and hearing aid dispensing to be completed all before a patient even leaves the hospital, although barriers do still exist.

Brief Summary of Clinical Takeaways:
The clinical takeaways of this session is to offer recommendations in consideration of inpatient audiologic testing protocols and provide guidance for the creation and function of an inpatient audiology team in a hospital setting. This session will also aid in providing tips for multi-disciplinary collaboration for medically complex patients.