1 NEWBORN HEARING SCREENS A hospital, parent and baby friendly newborn hearing screen provider Screen today for a sound tomorrow
2 Table of Contents Summary
3 Summary The Pediatrix Newborn Hearing Screen Program (Pediatrix NHSP) partners with hospitals to provide high-quality programs focused on early identification of infants with hearing loss. Early identification provides a unique opportunity for infants to receive early intervention which can dramatically increase their quality of life. For over twenty years, our team has screened more than 4.9 million babies nationwide; we currently screen more than 600,000 newborns annually in 30 states in more than 360 hospitals. According to the American Academy of Pediatrics (AAP), the referral rate for formal audiologic testing after screening should not exceed 4 percent. Utilizing automated auditory brainstem response (ABR) screening technology, our refer rate (babies who do not pass the hearing screen and need primary care/audiology assessment) is consistently less than 1 percent. Part of our program s strength is the dedication and continuity of our hearing screen staff. Pediatrix NHSP provides hospitals with skilled, dedicated and trained staff to manage the screening process. This dedicated team interacts with parents, audiology providers, primary care physicians, and state and community resources to help identify babies at risk for hearing loss and provide timely audiology assessment. With a sensitivity to cost, for both hospitals and patients, our goal is to screen 100 percent of eligible babies. We maintain policies, guidelines and procedures so that babies receive a high-quality screen, regardless of the family s ability to pay. We recognize each hospital is unique in its daily operations and tailor our programs to fit the needs of our partnering hospitals. Elements of our turnkey operation include: Staffing Data management and reporting Quality assurance Education ABR screening technologies
4 The collaborative efforts of the following corporate, regional and local teams support the unique services and products Pediatrix NHSP provides to parents, the community and partnering hospitals. National Resources Each member of the corporate team provides support to programs nationwide through quality assurance monitoring in their respective functions. In addition, the clinical director leads the clinical trending and research areas of Pediatrix NHSP. Regional Resources The site coordinator meets regularly with the medical physician sponsor to review program data, statistics and quality assurance measures. HIGHLIGHTS A dedicated hearing screen staff provides coverage 7 days a week, 365 days per year, including holidays. We provide national, regional and local support to our hospital partners. The regional manager and regional coordinator work together with the site coordinator to support a high-quality program. They monitor program quality, facilitate open communication with hospital administration and foster compliance with federal and state laws; hospital rules and regulations; and requirements and guidelines, such as Occupational Safety & Health Administration (OSHA), Joint Committee on Infant Hearing (JCIH), The Joint Commission (TJC), as well as Pediatrix s own internal requirements related to hearing screen personnel.
5 As the liaison for hospital personnel, the site coordinator handles program implementation and is responsible for the daily operations of the program. In addition to performing hearing screens at the bedside, the site coordinator provides parent education, analyzes statistics and data, conducts training, monitors the follow-up process, assists with state reporting, and provides administrative support, including appointment scheduling, hiring and other related matters. Pediatrix screeners perform the screen during convenient hours for the family while serving as a useful source of information for parents that may have questions regarding the incidence of hearing loss, the screening process or the baby s screen results. Educational videos are offered in 20 different languages, including sign language, for bedside viewing. Additionally, the screener offers printed Pediatrix NHSP literature in English and Spanish on the newborn hearing screen program including hearing milestones, the importance of follow-up for babies that refer, and monitoring for late onset progressive hearing loss. The Pediatrix NHSP screener is sensitive to the importance of a quality screen and will return, as needed, to screen a baby under optimal conditions.
6 Data Management, Reporting and Follow-Up We utilize a proprietary, web-based data management system, Soundata, to store hearing screen clinical data as well as track and analyze hearing screen results. Through our patient safety organization, MEDNAX PSO, LLC, Soundata stores clinical data on over 4.9 million babies screened through our program, including more than 19,000 babies who did not pass (refer) and needed primary care/audiology management. Data is easily uploaded into Soundata, which reduces the time and costs involved in data management. Standardized data fields allow for consistent collection and retrieval of data for tracking, as well as hospital and state reporting. However, the system is also flexible and can be modified based on specific site needs. Our hearing screen equipment is encrypted, which fosters the security of each patient s protected health information (PHI). track analyze report SOUNDATA We provide reports to our hospital partners annually or more frequently upon request. Through Soundata, we have the ability to provide annual population and outcome statistics, which include the number of deliveries, babies screened and babies who refer the hearing screen, in addition to other reports. Using Soundata, we are able to manage capture rates, track follow-up appointments and progress from the initial screen through the intervention process, if needed. Soundata s refer tracking module utilizes action codes to promote adherence to procedures, promote communication within the organization, and generate parent and physician letters. HIGHLIGHTS Web-based data management system, Soundata, helps store, track and analyze hearing screen results. Our hearing screen equipment is encrypted, which fosters the security of each patient s protected health information (PHI). Flexible system can be modified to provide data based on specific hospital needs. Data is easily uploaded and reported, which reduces the time and costs involved in data management. Standardized data fields allow for consistent collection, entry and retrieval of data for tracking, as well as hospital and state reporting.
7 The following table summarizes national program statistics: Births Eligible births 651, ,564 Number of eligible babies screened 651, ,680 Percentage of eligible babies screened 99.97% 99.44% Referred Babies Number of referred babies 5,130 8,190 Refer rate per year 0.79% 1.18% Outcomes Data Diagnosed hearing loss 1, Confirmed pass/pass re-screen (%) 2,547 2,342 Incidence of hearing loss per thousand Our data management system helps us maintain and monitor program quality benchmarks. We strive to: Maintain low refer rates/false positives Increase audiology follow-up for babies identified with potential hearing loss Reduce parent refusals Pediatrix Follow-Up Data Exceeds National Results Our standard of care exceeds the needs and expectations of hospitals and states for delivering high-quality service for babies and their families. What sets Pediatrix NHSP apart from any other program is the ability to interact and help coordinate with parents, primary care providers, audiology resources and state/community resources in the early detection and timely intervention of babies at risk for hearing loss National Data CDC* Pediatrix NHSP (29 States) Capture rates 97.9% (n = 3,713,991) 99.98% (n = 585,192) Refer rates 1.7% (n = 64,901) 0.5% (n=2,987) True incidence rates (babies with diagnosed hearing loss) Lost to follow-up/lost to documentation rates 1.5 per 1,000 screened (Range per 1,000) 34.9% (n = 20,615) (Range %) 1.5 per 1,000 screened 14.32% (n = 416) *Centers for Disease Control and Prevention (CDC) Summary National Early Hearing Detection and Intervention (EHDI). Please note Pediatrix NHSP data corresponds to the most current CDC data available. page 7
8 Quality Assurance To avoid interference with the discharge process, we strive to screen babies as soon as possible after birth. This allows us to rescreen a baby prior to discharge if he or she refers the initial hearing screen. The ability to perform the initial screen and rescreen, if necessary, reduces false positives, which can help to alleviate parental concern. Our total refer rate is less than 1 percent. According to the AAP, the referral rate for formal audiologic testing after screening should not exceed 4 percent. A low refer rate means fewer false positives and reduced stress on parents and community resources. We maintain newborn hearing screen protocols, policies, procedures and observe TJC and hospital requirements, and follow HIPAA, OSHA and JCIH guidelines. We comply with state reporting requirements, guidelines and certifications. We also participate in quality assurance activities, both internally and externally to evaluate, improve and maintain operational continuity. Our quality assurance activities include a checks and balances system supported by our team. We provide local, regional and national support to hospitals across the country. Regional management works in tandem with on-site staff to facilitate open communication with hospital administration and support a continuous high-quality program. We provide annual reports that include capture rates and other benchmark criteria in accordance with our program. To support quality improvement measures we provide continuing education to our hearing screen staff. Our data management system, Soundata, supports these efforts. Parent Satisfaction Parents receive the opportunity to provide feedback on the Pediatrix NHSP screen staff and the hearing screen process. They are encouraged to provide any additional comments to help us improve the program. HIGHLIGHTS To avoid interference with the discharge process, we strive to screen babies as soon as possible after birth. We comply with state reporting requirements, guidelines and certifications. We maintain newborn hearing screen protocols, policies, procedures and observe TJC and hospital requirements, and follow HIPAA, OSHA and JCIH guidelines. Parent satisfaction surveys help us evaluate and improve the service we provide. Parent satisfaction survey results are tallied and analyzed to identify any questions, concerns or issues that may need to be addressed Parent Satisfaction Surveys Approximate surveys distributed 120,030 Percentage Surveys received 26.42% Satisfaction rating 98.89% page 8
9 Education Parents An educated parent can be the best advocate for a child with hearing loss. Our on-site hearing screener provides parents with education about the hearing screen process and importance of hearing health. We support the Baby-Friendly Initiative to encourage infant feeding and mother/baby bonding by providing hearing screens at the bedside. To further emphasize the importance of the hearing screen and intervention when needed, we offer educational videos in 20 different languages, including sign language, for bedside viewing. Additionally, the screener offers printed Pediatrix literature in English and Spanish on the newborn hearing screen program including hearing milestones, the importance of follow-up for babies that refer the screen, and monitoring for late onset progressive hearing loss. We also Newborn Hearing Screen Information for Parents NEWBORN HEARING SCREENS provide a variety of newborn hearing health resources and a toll-free phone number to our corporate office for questions or comments. If an infant refers the hearing screen, we explain the results and the importance of follow-up in a culturally sensitive and understandable manner. Our concern extends beyond the initial screen. Our goal is to help facilitate the appropriate follow-up, including diagnostic assessment and intervention, for the children who need it. HIGHLIGHTS We provide educational videos in the following languages for bedside viewing. Arabic Bosnian Cambodian Chinese Creole English French German Hindi Hmong Japanese Karen Korean Polish Portuguese Russian Sign Language Somali Spanish Vietnamese Health Care Providers Ongoing communication with health care providers is a vital element of our hearing screen program. We submit information on infants who refer the hearing screen to their primary care provider for audiology referral and follow-up. We strive to maintain regular contact with both the audiologist and primary care provider, while providing parents with access to pertinent information and community resources. Hospital Personnel Pediatrix NHSP provides materials and in-services to our hospital partners upon request to support the importance of timely identification and early intervention of hearing loss. In-services may include educational modules and Grand Rounds that provide information on Pediatrix NHSP, including guidelines, parent education and hearing screen reports. We also provide an annual report to hospital administration outlining Pediatrix NHSP data specific to the hospital and conduct weekly or monthly staff meetings.
10 ABR Screening Technology Advances in technology allow the detection of possible hearing loss within the first day of life. Pediatrix NHSP provides, maintains and calibrates the hearing screen equipment necessary for a hospital s newborn hearing screen program. We utilize hearing screen equipment that has been cleared by the United States Food and Drug Administration (FDA) for use on newborns and infants. The equipment is fully automated and yields a simple pass/refer outcome. All Pediatrix hearing screens are performed using ABR screening technology. Only an ABR screen can identify auditory neuropathy, which can be present in the well baby population and not just highrisk babies in the NICU. ABR is considered the gold standard of hearing screening equipment and provides quality screens with a theoretical sensitivity of percent. Pediatrix NHSP also provides the supplies and disposables necessary. HIGHLIGHTS We utilize hearing screen equipment that has been cleared by the FDA. We provide, maintain and calibrate all needed equipment. We provide trained hearing screen personnel, as well as the supplies and disposables. We perform all screens using automated ABR screening technology, the gold standard of hearing screen equipment. Fully automated equipment yields a simple pass/refer outcome.
11 While both ABR and otoacoustic emissions (OAE) screening methods are safe and comfortable for the baby, they differ in their ability to detect the type of hearing loss and screening population protocols. OAE screens evaluate cochlear function. The screen involves placement of a small probe with a microphone in the ear canal while a computer analyzes the echo. If there is no echo response, hearing loss may be present and further evaluation is necessary. Central auditory processing problems cannot be detected with an OAE screening method. Additionally, due to fluid in the ear canal, more infants fail OAE screens as compared to ABR screens. ABR screening technology is less dependent on the status of the middle ear and, unlike OAE screening, evaluates both cochlear function and brain response to auditory stimuli. It can detect the rare condition of auditory neuropathy in children who are deaf but also have normal OAEs. ABR is recommended by the JCIH as the appropriate screening method for use in the NICU. Pediatrix NHSP utilizes this technology, not only for babies admitted to the NICU, but for all babies we screen. The JCIH also recommends a follow-up rescreen using ABR technology for babies who failed an OAE hearing screen in the Well Baby Nursery. ABR checks the entire hearing pathway from the ear through to the brainstem. Brainstem OAE checks only a portion of the pathway from the outer ear to the cochlea. Outer ear Cochlea
12 ABR Screening Technology The SmartScreener-Plus Fast, Portable and Easy-to-Use Hearing Screen System Easy to set up, three-sensor recording montage Screens both ears simultaneously Automated pass/fail results for each ear Pre-programmed screening parameters require no adjustments Pre-programmed detection click levels of 35 db nhl, equivalent to a whisper, to test each ear Pre-programmed objective spectral-based F-statistic detection to measure response repeatability compared to background noise Portable machine can go from room to room between hearing screens without shutting down and rebooting Parent educational videos on newborn hearing screens available in 20 languages, including sign language, for viewing and printing Certificates printed for babies who pass the hearing screen Reliable Operation Hearing screen and data uninterrupted in the event of power failure Counter Top Work Surface Computer Screen Cart Column Tension Adjustment Bins File Holder percent theoretical statistical bilateral sensitivity 96 percent specificity screening at a detection level of 35 db nhl Data Upload and Management Hearing screen equipment is encrypted, which fosters the security of each patient s PHI Results are printed and become part of the newborn s hospital medical record Data management system allows data upload to remote servers using wireless aircard Compatible with data management systems including: HI*TRACK OZ Systems Neometrics Soundata Facilitates creation of reports and letters Keyboard Mouse Printer on Shelf Base with Isolation Transformer Parking Brake (2) Up/Down Lever Supply Drawers Cart Power
13 Follow-Up Process Hearing Screen Follow-Up Process From the initial contact with the family to the confirmation of diagnosis by a community audiologist, our dedicated hospital program focuses on education, proper documentation and communication of results, parent feedback and facilitation of the audiology follow-up process for babies identified with potential hearing loss. This process reduces the burden of additional diagnostic costs incurred by the parent and community. We also provide pertinent instructions and directions to the outpatient rescreen location, which helps to reduce the number of babies lost to follow-up. STEP 1 STEP 2 STEP 3 Automated ABR screen provided to the newborn at the birthing facility. Complimentary outpatient rescreen provided at the birthing facility if needed, and state and hospital policy allows. Parent/guardian is reminded by phone or other correspondence of any scheduled rescreen outpatient appointments. STEP 6 STEP 5 STEP 4 Screen staff may facilitate the scheduling of an audiology diagnostic appointment, in collaboration with the parent/guardian. Primary care physician notified of hearing screen and/or rescreen results. Additional steps may be taken to locate the parent/guardian if the current contact information is not available. STEP 7 STEP 8 STEP 9 Screen staff helps coordinate with the primary care physician regarding pending audiology appointment for the baby s hearing screen follow-up. Screen staff confirms the parent/guardian kept the appointment for the baby. Screen staff maintains contact with parent/guardian of baby diagnosed with hearing loss to help provide support, facilitate audiology follow-up appointments and track information.
14 About Pediatrix Medical Group, Inc. Pediatrix Newborn Hearing Screen, LLC is a service of Pediatrix Medical Group, Inc. (Pediatrix). Pediatrix began as a single neonatology group in Today, it is the nation s leading provider of neonatal, maternalfetal and pediatric physician subspecialty services, as well as hearing screen services. Pediatrix s affiliated professional corporations employ more than 1,580 neonatal, maternal-fetal and pediatric subspecialists and more than 780 advanced practitioners in 34 states and Puerto Rico. For more than 30 years, our growth has been guided by our most valuable asset our clinicians and a simple principle: Take great care of the patient. While our company has its roots in neonatology, our commitment to infants and children made our evolution into other subspecialties and services not only possible, but a natural progression. OUR HISTORY Pediatrix began providing maternalfetal medicine physician services and formalized Center for Research, Education and Quality (CREQ) 1979 Pediatrix founded as a single neonatology group 1994 Pediatrix launched its newborn hearing screen program Pediatrix began providing pediatric cardiology and pediatric intensive care physician services 1996 Electronic health record module and clinical data collection capabilities introduced to bolster research, education and quality improvement initiatives 2000 Pediatrix NHSP Implemented proprietary data management system, Soundata SOUNDATATM
15 In addition to newborn hearing screen services, we provide a comprehensive scope of services to partnering hospitals, including: Maternal-Fetal Medicine OB/GYN Hospitalist Services Neonatal Intensive Care Newborn Nursery Care Newborn Hearing Screens Pediatric Hospitalist Services Pediatric Cardiology Pediatric Emergency Medicine Pediatric Critical Care Pediatric Surgery For more information about our services, please contact or go to BabySteps certified as an electronic health record module by the Certification Commission for Health Information Technology (CCHIT) 2001 Pediatrix introduced its continuous quality improvement program Patient safety organization formed to support our goal of establishing a patient safety culture while managing the review and analysis of patient safety work product Pediatrix introduced 100,000 Babies Campaign, a large-scale quality improvement initiative Pediatrix NHSP screened 1 millionth baby 2012 BabySteps Clinical Suite launches Spanish version in Colombia documenting over 9,000 NICU and well baby admissions and more than 28,000 daily notes in its first year
16 For More Information If you have any questions or would like to explore a partnership with Pediatrix NHSP, please contact us at your convenience. Call: Visit: Screen today for a sound tomorrow PREPARED BY: PEDIATRIX MARKETING 02/2014