18 August 2015

Improving Newborn Hearing Screening Programs

Thanks to a combination of policy and technology, newborn infant hearing screening programs have made tremendous progress over the past two decades. Policy changes — spearheaded by position statements from the NIH (1993) and Joint Commission for Infant Hearing (JCIH, 1994) and later supported by the American Academy of Pediatrics — drove meaningful discussion about the importance of early detection of hearing deficiencies, while advances in Automated Auditory Brainstem Response (A-ABR) technology made it possible to efficiently screen all newborns within 12 hours of birth. As a result, more than 97 percent of all U.S. newborns now receive a hearing screen before discharge from the hospital.

Because hearing loss is the most common congenital condition in the United States, this change has had a major positive impact on public health. The system is not yet perfect, though. Just as with any new process, these changes have introduced complexity to neonatal programs, and this complexity must be managed properly to extract the maximum benefit.

Because the hearing screen process is relatively routine and low-skill, the primary challenge for hospital management is less about process optimization than it is about staffing and training. Most staff issues can be traced to two related problems:

Poor Knowledge of Local EHDI Program

As part of the push to improve early hearing screening policy, the CDC set aside grants to support the development of Early Hearing Detection and Intervention (EHDI) programs at the state-level. While this provided states with additional flexibility to meet the national EHDI goals, it also led to the development of dozens of parallel processes for achieving the same result. Each state has its own ways of implementing EHDI programs and mandating continuing education for medical employees, and the quality of these implementations can vary widely.

This makes dealing with staffing issues and policy changes more challenging, for obvious reasons. Without a national standard (or high quality state-level one), hospitals can struggle to recruit staff that have the necessary skills to immediately contribute to the productivity of the screening program. This puts a significant burden on the hospital's human resources team.

Improper Training on Hospital SOPs

Staff that lack proper state-level EHDI training will naturally struggle with hospital-level standard operating procedures (SOPs). This case is surprisingly common: at some hospitals, many staff are unaware that their state even offers an EHDI program. When training is absent and these SOPs are poorly implemented, it creates “loss to follow-up,” “loss to documentation” and “loss to treatment” cases. These are essentially scenarios where process errors allow newborns who failed their screening to slip through the cracks and not receive appropriate follow-up care. According to the American Academy of Pediatrics, almost half the children who do not pass their screening ultimately fall through the cracks and do not receive a documented diagnosis.


There are many strategies for addressing these issues, but at their core they all share three things: a comprehensive knowledge of EHDI programs, a solid recruitment pipeline and a well-documented training and SOP library. While it is certainly an option for a hospital to develop these resources in-house, the majority find that partnering with a physician services organization is a more cost-effective solution. Unlike individual hospitals, physician services groups can apply scale to hearing screening programs, which means that staff pipelines are more robust and best practices can be implemented quickly across an entire network. In addition to these management practices, the scale offered by external groups allows them to easily implement best-in-class technologies, including pre-existing billing systems that simplify payment. In most cases, this leads to improved department performance at a lower cost when compared to an in-house solution.

If you're interested in learning more about how Sheridan can help make your hospital's hearing screen program as successful as possible, we encourage you to visit our Healthy Hearing website or contact us directly.