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Follow-up after a failed newborn hearing screen: a quality improvement study
Christy M Cockfield1, Gloria D Garner, Jack C Borders
1Medical University of South Carolina College of Nursing, Charleston, SC, USA.
Insights
A nurse practitioner teaching intervention significantly improved newborn hearing screening follow-up rates. Educating parents on audiology appointments reduced infants lost to follow-up, addressing a critical public health gap.
Area of Science:
- Pediatrics
- Public Health
- Quality Improvement
Background:
- Universal newborn hearing screening (UNHS) aims to detect congenital hearing loss early.
- Nearly 50% of infants with failed screens are lost to follow-up (LFU), hindering timely intervention.
- Existing research identifies LFU risk factors but lacks quality improvement studies to enhance follow-up rates.
Purpose of the Study:
- To implement and evaluate a nurse practitioner-led educational intervention to improve follow-up rates after failed newborn hearing screens.
- To educate parents on recommended audiology follow-up, aligning with Healthy People 2020 objectives.
Main Methods:
- A quality improvement project involving 17 newborn/mother dyads over six weeks.
- Nurse practitioners provided bedside education on UNHS and follow-up protocols.
- Retrospective chart review at three months post-birth assessed audiology follow-up or LFU for audiologic evaluation (LFUAE).
Main Results:
- 14 out of 17 infants (82%) had adequate audiology follow-up within three months.
- Hospital A achieved statistical significance, reducing LFUAE compared to national rates (p=0.01).
- Hospital B's LFUAE rate decreased from 70% to 40% post-intervention; maternal smoking was linked to LFUAE in two cases.
Conclusions:
- Nurse practitioner-led education prior to hospital discharge significantly improved audiology follow-up rates.
- Healthcare providers should prioritize parent education on follow-up guidelines and Healthy People 2020 objectives.
- Further research is recommended to assess six-month follow-up for hearing aid fitting and early intervention services.
Objective:
Universal newborn hearing screening (UNHS) has been implemented for several decades to screen for congenital hearing loss; however, the lost to follow-up (LFU) rate for newborns with a failed screen is nearly 50%. Many studies have examined risk factors rendering infants susceptible to being LFU, but there are no quality improvement studies using evidence-based practice that aim to improve follow-up rates. This study utilized a nurse practitioner (NP) to provide a teaching intervention to educate parents on recommended follow-up after a failed hearing screen, including the Healthy People 2020 objectives.
Methods:
Seventeen newborn/mother couplets were recruited to participate in a multi-site quality improvement project over a six week period prior to hospital discharge. At the bedside with the NP, mothers completed a demographic survey and were provided education on Georgia's UNHS Program and recommended follow-up based on the Healthy People 2020 objectives. An appointment with the hospital's audiologist was given to the mother in writing. A retrospective chart review was performed three months after the newborn's birth to document follow-up with audiology or to see if the infant was lost to follow-up for audiologic evaluation (LFUAE).
Results:
Of the 17 newborns enrolled, 14 had adequate follow-up with audiology within three months of birth. Hospital A showed statistical significance with one newborn that was LFUAE when compared to the nation LFU rate (n=12, p=0.01). Prior to project intervention, Hospital B had a 70% LFUAE rate; however, its post intervention LFUAE rate decreased to 40% (n=5). Statistical significance was unable to be obtained due to small sample size. Two mothers reported smoking during pregnancy and both of their newborns were LFUAE.
Conclusions:
This project suggests that education by the NP prior to hospital discharge was statistically significant at Hospital A. Health care providers should actively engage in educating parents regarding expected follow-up guidelines and incorporating the Healthy People 2020 objectives. Further studies are needed that can also examine the six month follow-up with pediatric otolaryngology for hearing aid fitting and early intervention.
