title: Identifying quality improvement opportunities in a universal newborn hearing screening program.
abstract: OBJECTIVE
  Hospital-based universal newborn hearing screening (UNHS) programs are encouraged to maintain quality assurance protocols, but many hospitals lack the time and resources to initiate this process. We studied a practical approach to measuring baseline quality indicators and identifying improvement opportunities in UNHS programs.
  
  
  METHODS
  We determined screening processes and quality indicators for UNHS programs at 4 hospitals through site visits and a 2-year retrospective review of nursery and audiology records. Nurses, audiologists, and otolaryngologists met for feedback of hospital-specific quality indicators. The sessions identified improvement opportunities and proposed system changes for immediate implementation.
  
  
  RESULTS
  Hospitals screened 21 957 newborns for hearing loss. Screening rates were >99% at all hospitals. Rates of referral and diagnostic testing varied significantly between hospitals. Low referral rates prompted 2 hospitals to adjust screening processes to reduce potential false-negative screening results. Two other hospitals addressed poor diagnostic follow-up by changing the referral process to include additional family contact information. Hospitals also increased referrals to Early Intervention Child Find services on the basis of our finding that these referrals increased the likelihood of diagnostic follow-up fourfold. We could not fully assess indicators of hearing aid eligibility and enrollment in early intervention services due to insufficient documentation.
  
  
  CONCLUSIONS
  Review of nursery and audiology records successfully established most quality indicators for the UNHS programs we studied. Feedback of quality indicators identified multiple improvement opportunities and facilitated endorsement of immediate system changes. This study demonstrates a practical and data-driven approach to quality improvement that can be used by any UNHS program.
authors.affiliation: Department of Otolaryngology–Head and Neck Surgery, University at Buffalo, State University of New York, Buffalo, New York, USA. kcdeem@gmail.com
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Deem
authors.forename: Ernesto A
authors.initials: EA
authors.lastname: Diaz-Ordaz
authors.forename: Brian
authors.initials: B
authors.lastname: Shiner
mesh_terms: D003266:Continuity of Patient Care; D016057:Evoked Potentials, Auditory, Brain Stem; D034381:Hearing Loss / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015997:Neonatal Screening / Q000592:standards*; D017084:Otoacoustic Emissions, Spontaneous; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation