EARly audit.

BACDA
British Association of Community Doctors in Audiology

EARly Audit:

Contents:

The role of a community doctor in audiology.

BACDA membership and work.

School hearing screening survey.

Training and publications.

Guidelines for Medical Investigation of Bilateral Severe to Profound Permanent Deafness in Childhood.

Connections with other professional bodies.

BACDA study day, CMV and hearing loss, January 2006.

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A National Audit of Hearing Impairment in Children (Funded by a grant from the DoH).
In 1999 BACDA reported on this national audit, which looked at age of identification of permanent childhood hearing impairment (PCHI). The audit analysed processes and outcomes of screening methods for PCHI; and provided national and regional measures against which services could be monitored locally.

Aims and Objectives:

To audit the age at detection, diagnosis and fitting of hearing aids for children with PCHI across the UK and to compare these with nationally agreed standards
To collect data about delays in the processes leading to detection and aiding, and to identify the reasons for delays.
To generate discussion of results by BACDA regional groups in order to facilitate local improvements in services.
To disseminate the findings to professional and voluntary bodies involved with these services.

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Standards - Based on NDCS targets for PCHI (Quality Standards, 1994):

80% identified by 12 months.
40% identified by 6 months.
Aided within 4 weeks.
>40dBHL better ear average (NDCS >50dBHL).
250 Hz information.
To provide audiological assessment within 4 weeks of 'precipitating event' rather than 'fitness to test.'

Additional standard of delays in diagnosis and fitting of hearing aids. Key stages, time from:

First suspicion to referral - not>6 weeks
Referral to confirmation - not>6 weeks
Confirmation to decision to aid - not>2 weeks
Decision to aid to aiding - not>4 weeks
Precipitating event to referral - not>2 weeks

Using these standards, a baby with PCHI who fails the Health Visitor Distraction Test and is referred at 9 months should have hearing aids fitted by 12 months.

Audit Sample:

Children with newly identified PCHI.
<40dBHL better ear average.
Between 01.01.94 and 31.7.95.

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**Degree and Type of PCHI**
Degree of PCHI	Congenital	Acquired	Progressive	Insuff info	Totals
Profound	76	25	3	15	119
Severe	104	8	8	16	136
Moderate	296	44	11	117	468
Insuff Info	27	2	0	13	42
Totals	503	79	22	161	765

Congenital PCHI
Median age in months at key stages
Degree of PCHI	Suspicion	Referral	Confirmation	Decision to Aid	Aiding
Profound	8(4-12)	9(5-14)	12(7-19)	12(8-18)	12(9-19)
Severe	8(3-14)	9(3-14)	13(8-21)	13(9-21)	14(9-22)
Moderate	10(6-28)	11(5-31)	19(9-44)	24(11-46)	26(13-48)
All	9(4-19)	10(5-22)	14(8-33)	16(9-34)	17(10-45)

**Comparison of Early results with NDCS Targets**
	Early	NDCS Tragets
Confirmation by 6 months	20%	40%
Confirmation by 12 months	43%	80%
Aided within 4 weeks of confirmation	40.3%	100%

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**Comparison of Early results with NDCS Targets where there were risk factors**
	Early	NDCS Tragets
Confirmation by 6 months	48%	40%
Confirmation by 12 months	74%	80%

**Delays**
Stage of delay	Child/family	Service	Planned
Between suspicion & referral	22	37	10
Between referral & confirmation	94	166	92
Between confirmation & decision to aid	24	62	67
Between decision to aid & aiding	38	61	24

Referral prompted by:

"At risk" screen - 26%
Parental concern - 24%
Health Visitor Distraction test (HVDT) - 22%
Professional concern - 18%
Parent awareness form - 0%

Messages:

Parental concern remains important.
Professional concern remains important.
Parent awareness form offers no apparent yield.
HVDT gave poor yield.

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