The Univ. of Iowa Hospital's screening program is carried out by CFYs and the
occasional staff person. Between all of us, we log in a lot of time just keeping
track of who needs to be screened, etc.
We attempt to screen all babies who are in the intermediate care nursery for more
than 48 hours, as well as well-babies with high risk factors, or babies who's
parents indicate they have a concern for hearing loss. We try and keep our miss
rate under 10% per 3 month period and we usually can achieve this goal.
Our follow-up, I fear, is lacking in many ways, but given our resources, it seems
the best we can do at this time. I have raised the issue of re-evaluating our
follow-up procedures but nothing has happened thus far. We don't have much time to
For babies we miss entirely, we send a registered mail letter stating that we
normally would've screened your kid but he/she was discharged before we were able to
do so and therefore ....blah blah hearing is important because....blah blah...we can
screen your child here or we refer you to your pediatrician, family doctor, AEA
(area education audiologists....Iowa actually has audiologists working for each
school district....AMAZING!) etc. For babies who fail one ear, we send a version of
the same letter and recommend behavorial testing in 6 months. I think this is a bad
recommendation since you still can't isolate ears at this age, but at least it
alerts the parent/caretaker that a problem might exist. For kids who fail both
ears, we recommend ABR at 2-4 months gestational age via letter format again. For
kids who pass both ears, no further testing is done unless they come back through
the oto clinic for some reason, or if the pediatric clinic refers the child to oto.
Originally, OTO tried making scheduled appointments for follow-up for babies who
failed or were missed and the percentage of no-shows was so high that they just
stopped doing it. With the miss babies, we send a stamped return addressed card
that has a number code on it to let us know who the card is for that, if returned,
lets us know the parent/caregiver actually did follow up on our recommendation and
what the results were. We get a low percentage of these cards back, however.
SO, that's how the chips fall around here. It's not the best system, but it
functions to a degree, and we have early IDed kids via this program--which is the
ultimate goal. Universal screening of the children in this hospital is not possible
with the staff we have right now and nursing cannot be asked to do the training
because of similar problems with workload.
smoore at otolaryngology-po.oto.uiowa.edu