At discharge, two questions need to be answered in relation to hearing:
- Has the baby had basic hearing screening (AABR)?
- Does the baby need early or targeted audiology follow-up?
Welcome to the Right Decision Service (RDS) newsletter for April 2024.
Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May. If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.
Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.
Thank you for your patience and understanding while we achieve a full resolution.
A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.
The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.
The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.
Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.
These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.
Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.
Figure 1: Impact of RDS on direct delivery of care
Key figures
Figure 2 shows RDS impact to date on delivery of health and care services
Key figures
These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.
Saving time and money
Quality assurance and governance
Service innovation and workforce development
A few examples of toolkits published to live in the last month:
Some of the toolkits the RDS team is currently working on:
Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.
Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions. We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.
Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine. The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
All babies should have a newborn hearing screen, unless parents decline following information about it. Each baby is given up to two tests, i.e. if no clear response is obtained on the hearing screen on initial testing in one or both ears, it will be repeated at least 6 hours later to see if a clear response can be obtained on one or both ears. If a clear response is obtained on either test in both ears and the baby has NO other risk factors requiring early or targeted follow-up, the baby needs no further reviews (see patient pathway below).
The test used in NHS Lothian is the automated auditory brainstem response (AABR), which tests for conductive hearing loss as well as sensory hearing loss. It has a high sensitivity (99%) and specificity (99%). However, it is susceptible to ambient noise and may also give a false positive result in premature babies due to an immature CNS.
Most term babies are identified on day 1 and screened in hospital by the Newborn Hearing Screeners. If babies are born at home, discharged early from LDRP, or discharged over a weekend, the Hearing Screeners track them down by CHI number and recall them to an outpatient clinic organised by Paediatric Audiology which may be at RHCYP or in the community.
Some babies require early audiology referral regardless of whether they have had AABR screening or not (See Section A of Risk Factors below).
Some babies who pass the initial AABR screen will still require targeted review at 8 months (See Section B of Risk Factors below).
The patient pathway following initial AABR screening is shown.
At discharge, two questions need to be answered in relation to hearing:
It is the responsibility of medical staff discharging babies from the Neonatal Unit to ensure that the AABR has either been done or to make it clear in the discharge letter that it still needs to be done.
AABR can be performed on the ward if the baby will still be an inpatient for a few days, and babies will be identified by the Hearing Screeners during weekdays. If the baby is discharged to the ward at the weekend and then goes home in the same weekend, the Hearing Screeners track them down by CHI number and recall them to Paediatric Audiology.
Please make it clear on the transfer letter whether the baby has had the initial AABR screen or not (premature infants usually only get it done before discharge home).
Please also make it clear to the receiving hospital whether or not the baby has risk factors requiring audiology follow-up.
With discharge planning, all ex-prems should have had the AABR done prior to discharge. Medical staff should help with obtaining consent for these babies as parents are not often in when the Hearing Screeners are around.
Term babies discharged directly home from the Neonatal Unit should have the AABR done at some point during their stay, unless their entire stay was over a weekend.
Medical staff doing the discharge letter need to highlight whether or not the baby has risk factors requiring audiology follow-up.
All babies who have risk factors requiring audiology referral should be referred to Paediatric Audiology for diagnostic assessment using the ‘Ward Referral to Paediatric Audiology’ referral form. If risk factors are identified please fill in the form and email a copy to Paediatric Audiology at audiology.rhcyp@nhslothian.scot.nhs.uk. For any urgent referrals please also copy in the UNHS manager Erin Moffat on erin.moffat2@nhslothian.scot.nhs.uk.
Risk factors requiring audiology follow-up1
A. Early audiology referral (these babies should be referred immediately to Paediatric Audiology on discharge from the Neonatal Unit regardless of whether or not AABR screening has been performed)
B. Babies requiring targeted review at 8 months, even if AABR screening is passed
C. If AABR is passed but the baby then develops any of the following, refer immediately to Paediatric Audiology for reassessment (this section is for babies who may have returned to the Neonatal Unit or Clinics after discharge from the wards)
1. Public Health England. 2019. Guidelines for surveillance and audiological referral for infants and children following newborn hearing screening. [online] Available at: https://www.gov.uk/government/publications/surveillance-and-audiological-referral-guidelines