Abstract
Objective: Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality improvement protocols, but many hospitals lack the time and resources to initiate this process. A practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs was studied.
Method: Screening processes and quality indicators for UNHS programs at 4 hospitals were determined 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. Improvement opportunities were discussed, and system changes were proposed for immediate implementation.
Results: Hospitals screened 21,957 newborns for hearing loss. Rates of screening were greater than 95% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust inpatient 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 recognized that referral to Early Intervention Child-Find services increased the likelihood of diagnostic follow-up four-fold (P = .03). Documentation of hearing aid eligibility and enrollment in Early Intervention services was insufficient for retrospective determination of these quality indicators.
Conclusion: Review of nursery and audiology records successfully established most quality indicators for the UNHS programs studied. Feedback of quality indicators identified multiple improvement opportunities and led to immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.
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