Modernising Hearing Aid Services

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Modernising Hearing Aid Services

• The Patient Journey
• The Patient Management System

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The Patient Journey

• Four variations -
• Direct referral
• ENT referral
• Re-assessment
• Repairs

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Direct Referral

• Pre-assessment
• Initial Assessment - 45 minutes
• Fitting - 45 minutes
• Optional Fine-tune 2 - 4 weeks later 30
  minutes
• Follow-up 8-12 weeks later 30 minutes

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Direct Referral Pre-Assessment - Audiologist

• Referral letter arrives
• Is the patient likely not to fit Direct
  Referral profile?
• If so, pass straight on to ENT
• Or probably suitable for audiology ?
• prioritise into urgent/priority/routine

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Direct Referral Pre-Assessment - Clerical I

• Is the patient already in the system?
• No - enter patient demographic information onto
  PMS
• Record the referral details
• Add patient to Direct Referral waiting list

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Direct Referral Pre-Assessment - Clerical II

• When they get to the top of the list
• Send patient /significant other /carer
  appointment with written information
• Alert patient to the GHABP questions
• allow them to think about the situations and
  their answers
• especially the last 4 which are specific to them

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Direct Referral

• Worksheet 1
• Pre-assessment
• 15 minutes

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Tasks for Worksheet 1

• Log onto AuditBase using the Training account.
• Check the patient is not already on the system.
• Record the patient's demographics and add a note
  to his record about when he is unable to attend
  an appointment.
• Create an initial referral for him.

• Find the Direct Referral waiting list and add him
  to it.
• Locate yourself at a future date on the calendar.
• Book him into a clinic from the Direct Referral
  waiting list for an initial assessment.
• Notify him of his appointment.

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Direct Referral so far

• Direct Referral pre-assessment
• Youve put a patient onto the system
• Youve booked an initial appointment for him

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Direct Referral Initial Assessment - Clerical

• Allow at least 45 minutes for the full
  assessment appointment
• Patient arrives
• Check demographic information on the system
  with the patient
• and amend if necessary

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Direct Referral Initial Assessment - Audiology I

• Take medical history
• including manipulation ability, vision
• Otoscopy
• Glasgow Hearing Aid Benefit Profile Part 1
• recorded direct onto the system

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Direct Referral Initial Assessment - Audiology II

• In test room
• Pure Tone Audiometry (AC / BC)
• Record results direct onto system
• Tympanometry where indicated

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Direct Referral Initial Assessment - Counselling I

• In interview or test room
• pre-fitting counselling
• including modifying expectations if necessary
• Who suggested a hearing test?
• Self? GP? Friends Family?
• What do they feel about trying a hearing aid?

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Direct Referral Initial Assessment - Counselling
II

• What do they expect a hearing aid will do for
  them?
• Discuss hearing aid options and agree
  type/model with patient
• Record decisions direct onto computer system

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Direct Referral Initial Assessment - Impressions

• Audiologist tasks
• Take impression(s)
• Choose venting/tubing
• Clerical tasks
• Hand patient information leaflet
• Book next appointment with patient
• Or add to waiting list for Fitting

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Direct Referral Initial Assessment - Clerical

• After the patient has left .
• Time passes
• Earmould stock check-in
• Reminder and fitting appointment

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Direct Referral

• Worksheet 2
• Initial Assessment
• 20 minutes

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Tasks for Worksheet 2

• Find the patient from the appointment book.
• Locate the date you set up for the patient's
  initial assessment.
• Check the patient in when they arrive, and
  confirm their demographics.
• Record Medical History.

• Record Otoscopy.
• Glasgow Hearing Aid Benefit Profile Part 1.
• Record Pure Tone Audiometry - NOAH3.

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Tasks for Worksheet 2

• Record outcomes of counselling aid options.
• Record earmould details after taking an
  impression.
• Make fitting appointment with patient present.

• Check the earmoulds into stock.
• Check in a batch of hearing aids from the
  manufacturer.

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Direct Referral so far

• Direct Referral Initial Assessment
• Youve taken a patient through the assessment
  appointment
• Youve looked at the stock module
• Youve booked a fitting appointment

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Direct Referral FittingAudiologist I

• Before patient arrives
• find the patient in the system
• review GHABP data and any special requirements
• Get aids and earmoulds from stock
• program according to manufacturers instructions

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Direct Referral Fitting Audiologist II

• Allow at least 45 minutes
• Patient arrives
• Check demographics
• Insert and check earmould

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Direct Referral Fitting Audiologist III

• Perform REM to verify by agreed protocol
• Using two modules, fitting and REM side by side
  in Noah
• Noah can be unstable in on-top mode using legacy
  hosts

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Direct Referral Fitting Audiologist IV

• With the aids on ..
• Evaluate subjective sound quality (including
  patients own voice)
• and fine tune if necessary

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Direct Referral Fitting Audiologist V

• Issue written information on
• the aids
• local services
• peer support
• Agree a programme of use
• Record in the patient notes section of PMS and/or
  appropriate screens

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Direct Referral Fitting Audiologist VI

• Book next appointment with patient
• Or add to waiting list
• tell them how long
• Refer them to peer group or user support service
  if one exists

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Direct Referral

• Worksheet 3
• Fitting Appointment
• 15 minutes

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Tasks for worksheet 3

• Find the patient from the appointment book.
• Locate the date you set up for the patient's
  fitting.
• Check the patient in when they arrive, and
  confirm their demographics.

• Issue the aid(s) from stock and record issue on
  the system.
• Record advice and fitting details in the journal.
• Book the patient straight into a Fine Tune
  Follow-up.

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Direct referral so far

• Youve taken a patient through the fitting
  appointment
• Youve looked again at the stock module
• Youve booked a follow-up appointment from the
  waiting list

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Direct Referral Follow-up Audiologist I

• 8-12 weeks after fitting
• Allow at least 30 minutes
• Glasgow Hearing Aid Benefit Profile Part 2
• Record direct onto system

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Direct Referral Follow-up Audiologist II

• Follow up on Glasgow responses
• How are they getting on?
• Different listening programmes

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Direct Referral Follow-up Audiologist III

• Fine tune if necessary
• based on patients comments
• REM if necessary
• Assess need for
• hearing therapy or ALDs
• further follow-up visits
• Write up notes in system

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Direct Referral Follow-up Audiologist IV

• End of Direct Referral process
• A co-operative patient with a straightforward
  problem goes away happy!
• Any questions?

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Direct Referral

• Worksheet 4
• Follow-up
• 10 minutes

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Tasks for worksheet 4

• Find the patient from the appointment book.
• Locate the date you set up for the patient's
  follow-up.
• Check the patient in when they arrive, and
  confirm their demographics.

• Glasgow Hearing Aid Benefit Profile Part 2.
• Fine-tune.
• Record advice and further details in the Journal.

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Direct Referral so far

• Direct Referral follow-up
• Youve taken a patient through the follow-up
  appointment
• Youve concluded the Glasgow questionnaire with
  them
• Youve recorded any extra fine-tuning

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Direct Referral

• Any questions about Direct Referral before we
  turn to our ENT patient?

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ENT

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ENT Referral I

• Is patient already in the management system?
• No - enter patient demographics on system
• Send patient /significant other / carer
  appointment, written information re. Glasgow
  questionnaire etc

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ENT Referral II

• First Assessment visit
• Allow at least 30 minutes
• Fill in any gaps in history
• including manipulation ability, vision
• FROM HERE ON PROCESS IS IDENTICAL TO Direct
  Referral

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ENT Referral

• Worksheet 5
• ENT
• 20 minutes

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Tasks for worksheet 5

• Add patient to ENT assessment waiting list.
• Book the patient into a clinic from the waiting
  list for an initial assessment.
• Notify the patient of their appointment.
• Find the patient from the appointment book.

• Locate the date you set up for the patient's
  initial assessment.
• Check the patient in, and confirm their
  demographics.
• Follow through ENT assessment to record any extra
  medical history, audiometry GHABP etc.
• Make a fitting appointment with the patient
  present.

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ENT Referral

• Youve re-visited the whole patient process using
  the ENT patient
• Any questions?

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Re-assessment

• Existing patients
• This is a different process for a different group
  of patients
• who are already hearing-aid users
• analogue moving over to digital
• paper records moving to electronic
• Less time taken overall

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Re-assessment I

• In repair clinic or routine review
• Is the patient on the system?
• if not, then enter patient demographics onto
  system
• Give patient /significant other / carer
  appointment, written information, Glasgow
  Difference Questionnaire

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Re-assessment Fitting Audiologist I

• Allow 60 minutes
• Any new medical history?
• Glasgow Hearing Aid Difference Profile Part 1
  (current aids)
• Otoscopy
• Retesting PTA (AC/ BC)
• Tympanometry where indicated

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Re-assessment Fitting Audiologist II

• Set up the hearing aids
• Modify earmoulds for comfort / ease of insertion
  if necessary
• REM to verify by agreed protocol
• adjust to target if required
• Evaluate sound quality fine tune

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Re-assessment Fitting Audiologist III

• With aids on, teach patient how to
• change battery
• operate controls
• switch between programmes
• Insert and remove (if required)
• use loop (if required)
• take care of aids (if required)

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Re-assessment Fitting Audiologist IV

• Hand patient information leaflet, written
  information on the aids, local services, peer
  support
• Book next appointment with patient
• Or add to waiting list
• tell them how long

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Re-assessment Follow-up Audiologist

• 8-12 weeks after Fitting
• Allow at least 30 minutes
• Glasgow Hearing Aid Difference Profile Part 2
  (new aids)
• Follow up on Glasgow responses
• REM, fine-tune .
• Record notes on system

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Re-assessment

• Worksheet 6
• Re-assessment
• 10 minutes

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Tasks for worksheet 6

• The patient has come into the Open Repair Clinic.
  Check if they are already on the system.
• Organise a re-assessment fitting appointment with
  the patient present.
• Record earmould (use existing ones) and hearing
  aid choices.
• Find the patient from the appointment book.

• Locate the date you set up for the patient's
  fitting.
• Check the patient in when they arrive, and
  confirm their demographics.
• Issue the aid(s) from stock and record issue on
  the system.
• Glasgow Hearing Aid Difference Profile Part 1.

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Re-assessment

• Thats it!
• Any questions?

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Repairs

• Stock module
• Scientific evaluation
• Cant rely on hearsay
• Walk-in Repair

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Walk-in Repairs Clerical

• Patient arrives (no appointment)
• repair hours may be open or restricted
• Receptionist greets
• ask about problem? Record book?
• Batteries only?
• record in book and issue batteries from stock on
  the system

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Walk-in Repairs Audiologist I

• Digital aid requiring replacement?
• Return and issue - stock module
• Connect to PC
• Bring up patient record on PC
• Program as per last fitted aid on that ear
• Patient Management System

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Walk-in Repairs Audiologist II

• Make appointment for new impression
• Do it there and then if time and .
• Make appointment for re-assessment
• waiting list?
• Patient Management System

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Repairs

• Worksheet 7
• Repairs
• 10 minutes

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Tasks for worksheet 7

• An existing patient arrives unannounced at the
  daily Repair Clinic. Check if they are already
  in the system.
• Book them into the Appointment book for a repair
  session today.
• Check the patient in, and confirm their
  demographics.

• Issue a new hearing aid.
• Program the new aid.
• Return the old defective aid to the manufacturer.

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