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Need caption for photo of sleeping newborn baby Pediatric Audiology: Before 3 Months

Improvement Strategies


Prioritize newborn diagnostic exams; create expedited slots and schedule two appointments at a time

Remind families of appointments one day in advance

Provide families with instructions for a successful evaluation

Verify the PCP/Medical Home

Identify two points of contact for families of infants who did not pass such as a relative or friend

Provide clear communication about next steps using the EHDI Care Map

Offer a referral to Guide By Your Side

Refer to early intervention (Birth to 3) within 48 hours of diagnosis

Pediatric Audiology: Introduction

Best Practice Guidelines


Review sample policies, procedures and competency guidelines that align with JCIH Guidelines.

Tools for Improvement


Assure follow-up with a few key data-collection and communication tools.

Improvement in Action


See how the collaboratives used improvement tools to test steps of change within their organizations.

Closing the Follow-up Gap: Pediatric Audiology

Determining the Diagnosis

DescriptionToday baby Bernice was brought into the Trinity Audiology Clinic for a diagnostic evaluation.  She is four months old.  Records indicate that she has not passed either the inpatient or outpatient OAE hearing screenings in either ear.  Baby is fussy when they arrive and mom reports that Bernice has a little cold today. 

The mother has read the Parent Preparation instructions that were mailed to her with the appointment reminder card, so Bernice is hungry and tired.  The audiologist places the electrodes, prepares the baby for the ABR and excuses herself from the room while mom feeds the baby and attempts to get her to sleep.  The baby settles easily and the ABR is conducted.  Threshold search indicates a moderate hearing loss bilaterally.  However, when the audiologist attempts to perform a wave V threshold search with bone conducted click stimuli , the baby awakes and mom is unable to get her settled back to sleep.  The audiologist is unable to perform OAEs or tympanometry to rule out middle ear involvement. 

The audiologist informs the mother that there is evidence of a hearing loss but that the results are inconclusive at this time.  She is provided with a copy of the Babies & Hearing Loss Notebook and instructed to make a follow-up appointment for 3 months from today for repeat testing.   The audiologist dictates notes for the chart and instructs a copy to be mailed to the child's medical home.  Since the configuration of the hearing loss has not yet been determined, the audiologist does not enter information into WE-TRAC and does not make a referral to the Guide By Your Side Program or the Birth to 3 Program, but makes a note to do so at the next appointment should the hearing loss be confirmed.

Discussion Points

  • How does the care align with diagnostic guidelines and best practices?
  • How is the family engaged?
  • How is care coordinated and communicated?
  • How do you find resources appropriate to this family's needs?
  • What staff training is needed?
  • Which improvement strategies could the medical home have implemented that would have assisted the family in getting to follow-up?
  • What could you do to diminish the impact congenital fluid has on the identification of permanent hearing loss? 
  • What can the audiology practice do to assure a successful evaluation including a full diagnostic ABR?