PC2174: Improving Hearing Screening in Children and Adolescents at an Ambulatory Indian Health Service Facility

Purpose/Objectives: We aim to improve the rate of pediatric hearing screening at an ambulatory IHS facility. Our goal is to obtain a 50% hearing screening rate in patients aged 1-17 receiving preventive care.

Design/Methods: Our original process for pediatric hearing screening was for Pediatrics to place a consult order to Audiology who would then call patients to schedule them. This process was inconvenient for patients since it meant additional visits. For cycle 1, staff from Audiology would physically come to well visits and perform hearing screening. As the Audiology schedule started opening up from closures related to the COVID-19 pandemic, this process was no longer feasible. For cycle 2, Pediatrics would give patients a physical “pass” so they could stop by Audiology after their appointment for their hearing screen. Cycle 2 resulted in a significant decrease in the rate of pediatric patients receiving hearing screening. In cycle 3, Audiology trained nurses in Pediatrics to perform hearing screening which they then performed at designated well checks (ages 4, 5, 6, 8, 10, 12, and 16.) Rates in cycle 3 were not improved, but there were extensive nursing absences due to COVID-19. During cycle 4, we repeated the cycle 3 process but the Pediatric clinic was not experiencing nursing shortages, and there was a great improvement. We measured the hearing screening rates via chart review. We measured the total number of hearing screens performed (92587 CPT code) in patients aged 1-17 out of all visits that use the 99392, 99393, and 99394 CPT codes (early childhood [age 1-4], late childhood [age 5-11], and adolescent [age 12-17]).

Results: Baseline (Nov 2019 – Jan 2020): 24%, cycle 1 (Dec 2020 – Feb 2021): 64%, cycle 2 (Apr 2021 – Jun 2021): 45%, cycle 3 (Aug 2021 – Sep 2021): 41%, cycle 4 (Nov 2021 – Dec 2021): 62%.

Conclusion/Discussion: Our initiative resulted in a significant improvement in the hearing screening rate at out clinic. We found that when we brought hearing screening to our patients at preventive care visits, we were able to meet our goal of a 50% hearing screening rate. This indicates that sending patient to a different location for screening is a barrier.

Disclaimer: The opinions expressed in this paper are those of the author and do not necessarily reflect the views of the Indian Health Service.