Independent report into newborn hearing screening released

Recommendations from a recently released report will further improve the quality of the newborn hearing screening programme, giving parents and caregivers increased confidence in their babies’ results and in the programme overall.

The report recommends simplifying the procedures used to screen babies and standardising the equipment used. It will mean more hearing loss will be detected through more sensitive and earlier testing, while reducing the inconvenience of outpatient appointments for families.

We commissioned independent experts in newborn hearing screening, audiology and health service management to complete the report following the screening incident where it was found that some testers were not correctly testing babies’ hearing.

Our investigation into this incident was focused on ways to strengthen how the programme is delivered by DHBs and how the National Screening Unit leads and monitors it. The investigation resulted in 21 recommendations and good progress has been made by DHBs to implement those. Of the 21 recommendations:

• 12 are completed
• the remaining recommendations are either substantially completed or well under way.
• The recommendations include:
• greater access to training
• better monitoring of the equipment screeners use and the information they collect
• clearer guidance on following the screening process
• conducting an independent review of the screening protocol (process).

The recommendations that have yet to be completed – and the recommendations from the recently released independent report – are substantial and will therefore take time to implement. Changing systems and replacing equipment across the country will require a lot of coordination. We’re working closely with DHBs to ensure the improvements are implemented in a timely and effective way.

As a result of the investigation and independent review, the programme is subject to even more careful monitoring at every step on the screening pathway. A wide range of systems are in place to check standards and we audit DHBs regularly and review detailed individual screener information.

We encourage parents and caregivers to have their babies screened early. If you have concerns about your child’s hearing you should contact your family doctor or Well Child provider.

Jill Lane, National Health Board National Services Purchasing Director

Related reports: Universal Newborn Hearing Screening Programme: Procedures, guidelines and reports

Further Background
 

Timeline of events

• July 2012: screening incident identified
• January 2013: NSU investigation report (Quality improvement review of a screening event in the Universal Newborn Hearing Screening and Early Intervention Programme) into the incident released containing 21 recommendations
• May 2014: independent report into the screening test (Review of newborn hearing screening regimes and associated screening devices) released. Accompanied by report outlining progress on implementing the 21 recommendations.

Independent report into the screening test released

Why was a report commissioned?

The National Screening Unit (NSU) of the Ministry of Health’s investigation into the screening incident resulted in 21 recommendations. The first recommendation was for the NSU to reassess the screening test with a view to changing to a single screening test. The best way to do this was to appoint independent contractors.

Who wrote the report?

Young Futures, independent contractors with expertise in newborn hearing screening, audiology and health service management.

What does the report recommend?

The report recommends that the Ministry of Health:

• implement a single screening test rather than the current two, and
• specify one type of screening equipment.

It also outlines the conditions for successful change (including things like a national data system and strengthened continuous quality improvement processes).

What’s happening as a result of the report?

The Ministry of Health will work with DHBs and other stakeholders on implementing the single screening test and the other recommendations. An implementation plan will be developed with the DHBs outlining the steps required. It will take some time to fully implement the recommendations as some of the changes are significant, and timeframes will be agreed with DHBs.

Parents and caregivers can have confidence in the quality of the screening programme

What checks do DHBs and the NSU have to ensure screening is done correctly?

A wide range of quality assurance systems are in place to ensure the newborn hearing screening programme is operating to a high standard.

All DHB newborn hearing services must comply with National Policy and Quality Standards (NPQS) produced and overseen by the NSU. Audits of DHBs against these standards and contractual requirements are carried out at regular intervals.

The screening programme is carefully monitored at each step on the screening pathway.

• The NSU collects screening and audiology follow-up data from DHBs and monitors performance of the programme against a set of national indicators.
• DHBs have comprehensive quality assurance processes for their newborn hearing screening services, including regular assessment of the performance of individual screeners.
• Downloads of screening data for each screener are checked weekly.
• Equipment checks are performed daily.

What are the benefits of finding a hearing loss early in the child’s life?

The hearing screening programme has a key target of identification of hearing loss by six months of age. This allows for intervention services to start working with the family as early as possible. If a hearing loss is not picked up early, this can lead to a delay in speech, language and communication skills. Children who began early intervention services by six months of age have been shown to have significantly better communication skills, parental bonding and parental grief resolution than those whose hearing loss is identified at a later age.

What other things can parents and caregivers do to check their baby’s hearing?

Parents and caregivers can monitor their baby’s hearing using the hearing checklist in their Well Child/Tamariki Ora book. This can also be found online at the The National Screening Unit (link to come) website.

About the screening incident identified in 2012

How and when was the screening incident discovered?

A review of data in July 2012 by two DHBs identified discrepancies in the recording of hearing screening results. This was investigated further and it was found that some babies were not screened according to the screening protocol. All DHBs were asked to review their data.

How many babies were potentially affected by the screening incident?

Around 5000 babies were identified as being potentially not tested correctly and were offered rescreening. These babies were from ten DHBs nationally.

Why did this happen?

Standard hearing screening processes were not followed during their screening.