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G606(P) A checklist improves guideline adherence for investigation of congenital hearing impairment
  1. S Badurdeen,
  2. V Sathyanarayana,
  3. S Murthy
  1. Specialist Children’s Service, Upton Hospital, Berkshire Healthcare NHS Foundation Trust, Slough, UK

Abstract

The British Association of Audiovestibular Physicians has provided guidance for the investigation for congenital hearing impairment. There is growing recognition that checklists improve quality of care in a range of clinical scenarios, particularly within anaesthetics and surgery, but evidence for their role in outpatient settings is limited.

Aims To conduct a complete audit cycle of investigations for all infants between 2010–2014 that were diagnosed with congenital hearing impairment by the Newborn Hearing Screening Service and referred to our community paediatric clinic. In the re-audit phase we retrospectively explored the usefulness of a simple user-checklist in improving adherence to the recommended investigations for each subtype of hearing impairment: unilateral (UI), bilateral mild-moderate (BM-MI) and bilateral severe-profound impairment (BSPI).

Methods All patients seen at our community paediatric clinic with congenital hearing impairment were included. Data were collected retrospectively from patient notes as well as electronic clinical data and results databases. Following the initial audit, results were disseminated to the clinical team. The checklist of recommended investigations that was used to gather data was made available for clinical use prior to re-audit.

Results Thirty-two patients were included. Between 2010–2012, all infants had a clinical examination, ophthalmology referral and genetic testing where indicated. Cytomegalovirus (CMV) testing was requested in 14/15 infants, and Family Audiograms in 12/15 infants. Urine dipstick for haematuria was done in 4/7 infants with bilateral hearing impairment, and electrocardiogram (ECG) done in 2/4 with BSPI.

Re-audit was performed for infants born between 2012–2014. The checklist of recommended investigations had been used in 7/16 infants (44%). In all 7 infants, including 3 with BSPI, 100% of the recommended investigations were requested. Overall, amongst infants with UI (n = 4) and BM-MI (n = 3), all recommended investigations were performed. Amongst those with BSPI, family audiograms were done in 6/8 infants and urine dipstick in 5/8 infants.

Conclusion Appropriate investigations are carried out in the majority of infants, but gaps remain in performing family audiograms and urine dipstick tests. Take-up of a simple checklist of investigations was moderate, but in all cases where it was used no investigations were overlooked. Universal take-up of the checklist and re-audit has been recommended.

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