Title: Managing an Irish Audiology Department in a Challenging Environment
1Managing an Irish Audiology Department in a
Challenging Environment
- 2009
- Martin Cromb
- Head of Department/Chief Audiologist
- Childrens University Hospital
- Temple Street, Dublin 1
2Introduction
- Head of Audiology since November 2002
- Share experiences and challenges over the last 7
years - Talk will include some Lean Management approaches
although not exclusively about Lean Management
3Providing a World Class Audiology Service
- Unlimited trained staff
- State of the art facilities and equipment
4The Reality
- Finite resources for most countries
- Allocation of resources varies from country to
country
5 How does ROI compare?
- ROI has approximately 1/3 of the number of
Audiology Professionals per head of population
compared to the UK / England - Can we provide the same level of services?
6Audiology Staff a Scarce Resource
- It is important that Audiology staff are used
appropriately - The ISA Audiology questionnaire 2008 found that 8
out of 22 Audiology Departments (36) had no
admin staff - Implication is Audiology staff are spending time
doing admin work instead of seeing patients
7CUH Audiology Department
- Department structure
- 3.5 WTE permanent staff. Same staffing levels as
2000. - Martin Cromb Head of Dept/Chief Audiologist
- Jennifer Sim Deputy Head/ Senior Scientist
- Louise McCusker Senior Audiologist
- Cliona Carey 0.5 WTE Admin Assistant
- 2 x 0.5 WTE staff on temporary contracts
- Caroline Doherty Associate Audiologist
- Cora McDermottroe Admin Assistant
8Good Skill Mix
- Enough staff able to perform all clinical
activities - Good flexibility for e.g. annual leave, sick
leave etc. - Senior staff performing specialised work most of
the time
9Role of the Associate Audiologist
- To provide a supporting role for
Audiologists/Scientists - VRA / Distraction
- Screening
- A/C audiometry and Tymps
- ? Neonatal screening
10Services Provided by CUH Audiology Department
- Diagnostic services are provided for
- CUH Professionals, including 4 ENT Consultants
- Neonatologists based at the Rotunda Maternity
Hospital
11Activity Level
- Overall activity levels have increased between
2003-2008 - Tests at ENT outpatients have remained constant
at approx 1700 per year - Assessments at SFC have increased
- 2003 829 assessments performed
- 2006 1344 assessments performed
- 2008 1636 assessments performed
12Waiting Lists for SFC
- 2003 - 6 weeks waiting period
- 2006 12 months waiting period
- 2009 6 months waiting period
13Development of Services
- 4th ENT Consultant
- More comprehensive range of assessments from 2002
onwards - In 2002 OAEs introduced
- In 2002 existing ABR equipment was utilised
- In 2003 ABR under G/A was introduced
- In 2003 VRA was introduced
14Increase in Demand
- Large increase in referrals for objective
measurement testing - In 2002, 16 children under 3 years of age had an
objective measurement assessment. - In 2003, 60 children under 3 years of age had an
objective measurement assessment. - In 2006, 133 children under 3 years of age had an
objective measurement assessment. - Over 50 of these children were referred by the
Rotunda Maternity Hospital. - The development of an un-resourced ad-hoc
at-risk Hearing Screening Programme for the
Rotunda Hospital
15Crisis, What Crisis?
- 2006 waiting lists of 12 months
- Increase in demand for services
- No increase in staff due to staff ceiling
16Agreement for a Structured At-risk Screening
Programme
- In 2006 an agreement was reached with
Representatives from CUH, PCCC HSE Dublin North
East, HSE Hearing Services, Deaf Hear, Rotunda
Maternity Hospital and the Cochlear Implant Unit
at Beaumont Hospital. - Phase I Screening of babies, who have spent
greater than 48 hours in Neonatal Intensive Care
Unit (NICU), using Automated Auditory Brainstem
Response (AABR) testing. - Establishment of the programme to act as a
springboard towards UNIVERSAL Newborn Hearing
Screening.
17Progress Prior to Launch
- Funding secured in 2007
- Assessment of facilities at the Rotunda
- Job descriptions
- Purchase of AABR equipment
- Recruitment and training of staff
- Funding for 3 WTE Audiology Professionals,
0.5 WTE Admin assistant
18UNHS Steering Group
- Formation of UNHS Steering Group at the
instruction of Brendan Drumm - Funding for CUH at risk screening program
withdrawn due to the belief that UNHS would be
implemented in the near future. - In the meantime Rotunda Hospital continued to
refer increasingly larger numbers of at risk
babies to CUH -
- Holles Street requested at risk screening service
due to withdrawal of services from Eye and Ear
Hospital -
19What Happened Next?
- Multidisciplinary Team Meeting including ENT,
Neonatologists, Chief Executive of CUH, Patients
Services Manager and Audiology - Outcome Service defined.
- no new service for Holles Street
- limited service for Rotunda Hospital
20- Doing The Best
- With What Weve
- Got
21To review or not to review, that is the question
- Individual Clinical Judgement used prior to 2008
- Patients sometimes received a different service
depending on which member of staff was seen - Review procedures and policies were created in
2008 - More standardised approach when reviewing
-
223 Areas Covered
- Review following behavioural assessment, children
lt 3 years of age - Review following a satisfactory neonatal
assessment - Review following referral to Hearing Aid Services
23Targeting Resources by Working in Partnership
with ENT
- Basis for the procedure created for behavioural
assessment review. - Most children lt 3 referred to Audiology have a
mild/moderate hearing loss with flat tymps. B/C
testing is rarely possible. - Prior to 2008 some staff would review, others
would leave the decision to review to ENT - Prior to 2008 referrals sent to Audiology
following grommet insertion were usually not
given priority
24Consequences of the System Prior to 2008
- Some children had multiple assessments between
ENT appts - Was value added by doing this?
- Some children referred to Audiology after surgery
were tested when grommets were blocked/extruded - Possible delay in diagnosis of S/N hearing loss
25Action Taken
- Discussion with ENT
- Clarified ENT are responsible for requesting
further testing following surgery or to monitor
if surgery not appropriate. - reduction in the no. of reviews between ENT
appts - Referrals for post grommet testing are now given
priority appts. - Resources are targeted to out-rule underlying S/N
hearing loss
26Review after Satisfactory Neonatal Assessment
- Risk of delayed onset hearing loss
- NHSP guidelines were used as a basis for the
procedure - Evidence based approach
-
27Referral to Hearing Aid Services
- CUH provides diagnostic services
- When there is definite diagnosis of hearing loss
requiring hearing aids, patients are not reviewed - Avoids duplication of work performed by Community
Audiology Services
28Reduction of Admin Work and Duplication of
Appointments
- Standardised reports
- Tick box stickers
- Staff tick the box indicating what written/verbal
information has been given - In response to National Hospitals Office
requirements for documentation of advice given to
parents/patients - New recording system using PAS to eliminate
duplication of appointments
29Ownership Issues
- Limited number of rooms, computers and telephones
- Resources follow Departmental needs
- No one owns any given room or equipment
30Role of the Head of Department
- Responsible for the most appropriate use of the
depts resources - Determines what work is booked in for each member
of staff depending on - Referrals received
- Availability of rooms, equipment and staff
31The Future
- Sound Field Room Refurbishment
- 8 weeks without testing facilities
- How do we reduce impact on waiting lists?
- Solution
- ? Change in working week
- ? Longer hours leading up to refurbishment
- ? Time in lieu when work is being carried out
- New sound attenuating room
- Capacity issues are limiting the number of sound
field testing assessments
32Conclusion
- In the last 7 years tried to develop services
using a structured resourced approach - Redefinition of services provided has been
required in an environment of changing resources - Optimisation of resources at any given time is an
ongoing process - Moving towards greater standardisation by
creating policies and procedures
33- Thank you for your time
-
- Any Questions
34(No Transcript)