P2D259: Quality Improvement on Early Hearing Detection, Education of Parents & Risk Factor Identification

Purpose/Objectives: We aim that in 6 months period from November 2021 to April 2022 that 90% of the total newborn admissions will have documentation in their medical record about hearing screen result discussion and counseling with the family before hospital discharge.

Design/Methods: We conducted the quality-improvement project in the Neonatal units of our hospital between October 2021 and April 2022. We conducted two PDSA cycles, lasting 3 months each. We did a baseline chart review of all babies discharged from the Nursery(4C) and Neonatal Intensive Care Unit(4D) to assess the quality of hearing screen results in the documentation. Our first intervention in November 2022, was the education of providers (Residents, Nurse practitioners, and Physicians) about the importance of hearing result discussion with parents and also a standardized approach to documenting results discussion. We followed the documentation rate for the next 3 months and identified limiting factors to our project. We conducted a second intervention in February 2022 with the introduction of a smart phrase and a hard stop that would remind the provider in the note about the discussion of the result with parents. We evaluated the effectiveness of interventions for the following 3 months.

Results: We reviewed a total of 539 charts. At Baseline, all patients had a documented hearing screen but lost to follow-up after failed hearing screen. Providers were not documenting the results of the discussion with the parents and hearing loss risk factors( < 2%). During the next 3 months, documentation increased to 43%. Feedback from providers identified the increase in the workflow as a major limitation. Introducing a smart phrase would help the provider in documenting and also force them to stop at that part of the note and be a constant reminder to discuss these results
with parents. For the next 3 months, documentation improved to 92%. We identified the limitation of the second phase and it was a new provider (external rotator) who was not oriented sufficiently about our department protocol. Although the average of 3 months was 92% the documentation was 98% in April 2022. The next step would be to verify the sustainability of our intervention and to evaluate if the loss to follow-up after failed hearing test decreased to less than 1%.

Conclusion/Discussion: The introduction of templates and reminders in the EHR made a key difference to the consistency in which assessment, documentation, counseling, and follow-ups occurred. By having these reminders, care providers were able to address the issues related to early hearing and detection. We, therefore, improved the patient experience, and parent awareness, as well as improved the quality of care.