Hospital Evaluation and Outreach: A State Example Stephanie Disney, Lou Ann Jones, and Carolyn Kisler Kentucky UNHS Regional Coordinators Never tell people how to do things. Tell them what to do and they will surprise you with their ingenuity. George S. Patton Aim Promote excellence Provide consistent standards for all hospital hearing screening programs in Kentucky Provide guidelines that encourage continuous quality improvement Provide a standardized method of program evaluation Enable hospitals to achieve the highest rating within the parameters of their own facility Evaluate each hospital program annually Promote compliance through education, evaluation and specific support Introduction The Early Hearing Detection and Intervention process begins at the level of the hospital hearing screen. Referral rates, nursing training, and hospital communication and contact, all significantly impact the ability of the entire EHDI system to provide quality, seamless services to families. In 2002 the Kentucky EHDI team developed a hospital compliance manual that addresses several key compliance issues including: Test Protocols, Hospital Policy and Procedures, Equipment, Test Area, Data Submission, Hospital Data Monitoring, Contact and Consultation, Parental Consent and Information, and Annual Staff Training. Within these topic areas important concepts such as referral rate, dissemination of parental information, equipment maintenance, number of tests performed, and information submission is addressed. The Hospitals Births per year [55,000/year] Low 200 or fewer Medium 1000 or fewer High 1000 or greater Nursery issues LDRP Units Well baby NICU [Level 1, 2, 3] Combinations Variety of test equipment AABR DPOAE TEOAE Variance of division of labor Variety of philosophies I.e. Military vs. Civilian Rural and urban facility Variety of follow up support systems Staffing and other issues The Ten Standards Test Protocols Policy and Procedure Equipment Test Area Data Submission Hospital Data Monitoring Specific Data Monitoring Contact and Consultation Parental Information Staff Training. Assessment and Adaptation In 2004 the Kentucky EHDI Team met to review the manual and the evaluation tool, following completion of annual hospital evaluations. During this assessment issues involving ambiguity of language, scoring, and new state requirements were discussed. Minimal changes involving the manual language were approved, implemented and reviewed. Additionally, areas of the evaluation tool were broken into smaller units for clarification and scoring purposes. Finally, a continuous quality improvement section was added to assist hospital programs deal with specific areas of weakness rather than simply looking at the total score. The EHDI team continues to work closely with the UNHS hospitals in Kentucky to support those programs and provide the assistance necessary to provide quality, seamless services to families. Therefore, the Hospital Compliance Manual and the evaluation tool and process continue to be works in process Hospital Annual Evaluation Score Summary Page There are 59 UNHS hospitals in Kentucky Locations of UNHS Hospitals Governors Focus for Kentucky Health Care – Education – Economic Growth Ernie Fletcher Governor James W. Holsinger, Jr., M.D. Secretary Cabinet Goals Provide the best preventative services through our public health programs; Provide the most outstanding services for families and children; Provide the finest health care possible for people in our state facilities; Protect children, elders, and people with disabilities, and prevent abuse; Build quality programs across-the-board; and Make a difference in the lives of all Kentuckians. Secretarys Guiding Principles for Professional & Personal Lives Do the right thing the right way the first time. All decisions must pass the three-way test: Is it Legal? Is it ethical? Is it moral? Quality service is the most effective service.

Hospital Evaluation and Outreach: A State ExampleAcknowledgements Kentuckys UNHS Hospitals, Reviewers of Hospital Compliance Manual, Joint Committee on Infant Hearing (JCIH), American Academy of Pediatrics (AAP), National Center for Hearing Assessment and Management (NCHAM), and the Centers for Disease Control-EHDI Division. Birthrate 450/year No Nursery/LDPR Screening done by Early Detection and Intervention Staff Screening Equipment: AuDX Refer rate 4% Test Rate (prior to discharge) 86% Test Rate including out patient 95% 2003 Evaluation Date of Evaluation: April 7, 2004 EDI Staff now have authorization to use procedure room in LDPR area and to transport neonates to that quiet area for screening. Weekend discharges still are not screened as inpatients. Future Building Opportunities Build on these hospital relationships to educate providers, parents, and the community about Early Hearing Detection and Intervention (EHDI) Build on these hospital relationships to identify areas of community strengths and weaknesses that impact the EHDI follow up goals. Build a team of community partners that includes hospitals, community leaders, service providers, health departments, educators, parents and other stakeholders, to focus on the development of a community infrastructure that assures follow-up for all newborns who refer on the hearing screening. Build a team spirit that seeks to motivate, equip and mentor fledgling EHDI community groups as they seek to find ways to meet the national goals. Current Continuing Education Trainings Offered for Hospital Staff Introduction to UNHS in Kentucky The Risk Indicators Late Onset and/or Progressive Hearing Loss A Sound EnvironmentNoise and the Neonate A model for protecting and preserving the health of the pre-term or fragile newborn Improving UNHSBe guided by the ten standards Educating Parents of Neonates on Early Hearing Detection and InterventionWindows of Opportunity Norton Suburban Hospital Louisville, KY Birthrate 5000/year Three nurseries located on 2 floors Level III NICU Screening Equipment: ALGO 3, ALGO 2 (2 units) Refer rate 2% Test Rate 98% 2003 Evaluation 2004 Evaluation Ireland Army Community Hospital Ft. Knox, KY Three Rivers Medical Center Louisa, KY Birthrate 160/year Single Nursery Screening Equipment: Madsen ECHO Screen Refer rate 5% Test rate 98% 2003 Evaluation Date of Evaluation: June17, 2004 Screening Personnel: Audiology Partners--Staff from a local ENT office