Audiologist. Practice area 179. Background

Transcription

1 Practice area 179 Clinical PRIVILEGE WHITE PAPER Audiologist Background Audiologists diagnose, treat, and manage patients who have hearing, balance, and related ear problems. They work with patients of all ages. According to the American Academy of Audiology (AAA), audiologists determine appropriate patient treatment of hearing and balance problems by combining a patient s complete history with a variety of specialized auditory and vestibular assessments. In addition, audiologists can dispense and fit hearing aids and provide hearing and balance rehabilitation training. According to the AAA, audiologists dispense the majority of the hearing aids in the United States. These health professionals typically conduct hearing tests in sound-treated rooms with calibrated equipment. They are trained to inspect the eardrum with an otoscope, perform limited earwax removal, conduct diagnostic audiologic tests, and check for medically related hearing problems. Audiologists refer patients to otolaryngologists when a hearing or balance problem requires medical or surgical intervention. According to the AAA, audiologists hold a doctoral degree in audiology (AuD) from an accredited college or university and have special training in preventing, identifying, and assessing hearing disorders, as well as in delivering nonmedical treatment of hearing disorders. However, as of 2007, the AAA and other entities stopped accepting a master s degree as an acceptable level of education, requiring instead that new applicants have an AuD. The AAA also requires applicants to complete a full-time internship and pass a national competency examination. Audiologists can obtain a Certificate of Clinical Competence in Audiology (CCC-A) by the American Speech-Language-Hearing Association (ASHA). They may also choose to become board-certified by the American Board of Audiology (ABA). All states require audiologists to be licensed or registered. Licensure or registration requires at least a master s degree in audiology; however, a first professional, or doctoral, degree is becoming increasingly necessary, according to the U.S. Department of Labor. Audiologists may be found working in hospitals and medical centers, schools and universities, physician offices, outpatient care centers, nursing homes, and hearing aid stores. Some are in private practice.

2 The Credentialing Resource Center (CRC) recommends that facilities authorize and assess competency for audiologists through the HR process rather than credential and privilege them through the medical staff process. In standard HR.1.20, The Joint Commission (formerly JCAHO) has identified a specific group of nonphysician healthcare professionals (i.e., physician assistants and advanced practice RNs) who must be credentialed and privileged through the medical staff process. The CRC advises that all others should be authorized and monitored through the HR process, as long as the process is commensurate to the method applied to hospital-employed practitioners performing the same or similar jobs. (For more information, refer to standard HR.1.20, EPs 11 and 12, in The Joint Commission s Comprehensive Accreditation Manual for Hospitals. All standard numbers are subject to change.) Note: Facilities that enable audiologists to perform exceptionally complex procedures or services may consider credentialing and privileging them through the medical staff process. However, this would be an exception and not the recommended rule. Involved specialties Audiologists, speech-language pathologists Positions of societies and academies AAA The AAA, a professional organization composed of more than 10,000 audiologists, outlines its position statement regarding the scope of practice for audiologists in its publication, Audiology: Scope of Practice. The AAA states: The scope of practice of audiologists is defined by the training and knowledge base of professionals who are licensed and/or credentialed to practice as audiologists. Areas of practice include the audiologic identification, assessment, diagnosis, and treatment of individuals with impairment of auditory and vestibular function, prevention of hearing loss, and research in normal and disordered auditory and vestibular function. To better define its scope, the AAA separates the practice of audiology into the following categories: Identification: Audiologists develop and oversee hearing screening programs to detect hearing loss in individuals. They may perform speech-language screening or other screening measures for the purpose of identifying and referring patients with other communication disorders. Assessment and diagnosis: These functions are accomplished using standardized testing procedures and appropriately calibrated instrumentation, which leads to the diagnosis of hearing and/or vestibular function impairment. Hearing assessment includes the administration and interpretation of behavioral, physioacoustic, and

3 electrophysiologic measures of the peripheral and central auditory systems. Vestibular assessment includes administration and interpretation of behavioral and electrophysiologic equilibrium tests. Treatment: Audiologists provide a full range of audiologic treatment services for patients with impairment of hearing and vestibular function. An audiologist may: Evaluate, fit, and verify amplification devices, including assistive listening devices Determine the appropriateness of amplification systems, evaluate benefits, and provide counseling and training regarding their use Conduct otoscopic examinations Select, fit, evaluate, and dispense hearing aids and other amplification systems Clean ear canals and remove cerumen Take ear canal impressions; and select, fit, evaluate, and dispense hearing aids and other amplification systems Assess and provide treatment for patients with tinnitus, using techniques such as biofeedback, masking, hearing aids, education, and counseling Recommend and provide rehabilitation of impairments of vestibular function Provide audiologic treatment services (e.g., clinical treatment, home intervention, family support, and case management) for infants and children Act as a member of an implant team (specializing in cochlear implants, middle ear implantable hearing aids, fully implantable hearing aids, bone-anchored hearing aids, and all other amplification/signal processing devices) that determines candidacy based on hearing and communication information Provide pre- and postsurgical assessment, counseling, and all aspects of audiologic treatment including auditory training, rehabilitation, implant programming, and maintenance of implant hardware and software Provide counseling regarding the effects of hearing loss on communication and psychosocial status in personal, social, and vocational arenas Administer audiologic identification, assessment, diagnosis, and treatment programs to children with hearing impairment from birth through school age Act as part of the team within the school system that manages students with hearing impairments and students with central auditory processing disorders

4 Participate in the development of individual family service plans and individual education plans; serve as a consultant in matters pertaining to classroom acoustics, assistive listening systems, hearing aids, communication, and psychosocial effects of hearing loss; and maintain classroom assistive systems as well as students personal hearing aids Administer hearing screening programs in schools, and train and supervise nonaudiologists who perform hearing screening in the educational setting Hearing conservation: An audiologist may also design, implement, and coordinate industrial and community hearing conservation programs. This process entails identifying and improving noise-hazardous conditions, identifying hearing loss related to these conditions, recommending and counseling use of hearing protection, educating employees, and training and supervising nonaudiologists performing hearing screening in the industrial setting. Intraoperative neurophysiologic monitoring: An audiologist may administer and interpret electrophysiologic measurements of neural function, such as sensory- and motorevoked potentials, tests of nerve conduction velocity, and electromyography. These measurements are used in differential diagnosis, pre- and postoperative evaluation of neural function, and neurophysiologic intraoperative monitoring of central nervous system, spinal cord, and cranial nerve function. (For more information on this procedure, see Clinical Privilege White Paper, Intraoperative neurophysiological monitoring and interpretation Procedure 242.) Research: Audiologists design, implement, analyze, and interpret the results of research related to auditory and balance systems. Some audiologists, by virtue of education, experience, and personal choice, choose to specialize in an area of practice not otherwise defined. In its position statement, The Professional Doctorate (AuD), the AAA states: The American Academy of Audiology endorses the concept of the professional doctorate in audiology as the appropriate entry-level degree for the practice of audiology. The advanced level of training the professional doctorate mandates is necessary to ensure the provision of the highest standards of delivery of service to individuals with auditory and other related disorders and to their families. The professional doctorate establishes audiologists in a clearly defined and prominent role within the hearing healthcare delivery system and strengthens their position as autonomous practitioners and providers of audiological services.

5 In this statement, the AAA also states that professional doctorate programs in audiology must surpass the academic and training experiences provided by the programs at the master s level. Doctorate programs must include at least four years training and education after the completion of accredited baccalaureate work and must be of sufficient breadth and depth. The degree designation of AuD is an entirely different degree designation than that of the PhD, which is a professional degree and is research-oriented. According to the AAA, many state laws require updating to recognize the AuD. Contact your state licensure board or regulatory agency for exact licensure, certification, or registration requirements. The AAA also offers fellow and affiliate memberships. Membership as a fellow is open to all audiologists who, at minimum, have been awarded a master s degree in audiology or the equivalent from an accredited institute of higher learning. Fellows must be licensed to practice by their state or have proof of completion of 350 hours of supervised clinical practicum and proof of successful completion of a national examination in audiology. Applicants for membership as fellows who graduated in 2007 or later must hold a doctoral degree with a major in audiology from an accredited institute. Applicants graduating in 2006 or earlier may apply with, at minimum, a master s degree. Affiliate membership is open to those who hold at least a master s degree from an accredited institute of higher learning and who have an active professional interest in hearing, hearing science, and audiology. ASHA The ASHA is a professional, scientific, and credentialing association of more than 130,000 members and affiliates who are audiologists; speech-language pathologists; and speech, language, and hearing scientists, according to its Web site. The ASHA also offers a CCC-A, criteria for which is included below. In its 2004 Scope of Practice in Audiology, the ASHA states: Audiologists are professionals engaged in autonomous practice to promote healthy hearing, communication competency, and quality of life for persons of all ages through prevention, identification, assessment, and rehabilitation of hearing, auditory function, balance, and other related systems. They facilitate prevention through

6 the fitting of hearing protective devices, education programs for industry and the public, hearing screening/conservation programs, and research. The ASHA also notes that audiologists education and training qualifies them to assess and diagnose dysfunction in hearing, auditory function, balance, and related disorders. The delivery of audiologic (re)habilitation services includes not only the selecting, fitting, and dispensing of hearing aids and other hearing assistive devices, but also the assessment and follow-up services for persons with cochlear implants, according to the statement. Audiologists who provide audiologic rehabilitation do so through a comprehensive program that includes therapeutic services, devices, counseling, and other management strategies. Functional diagnosis of vestibular disorders and management of balance rehabilitation is another aspect of the professional responsibilities of the audiologist. Audiologists engage in research pertinent to all of these domains, states the ASHA. According to the ASHA, audiologists scope of practice includes prevention and assessment of auditory, vestibular, and related impairments, as well as the habilitation, rehabilitation, and maintenance of people with these impairments. The professional roles and activities of the audiologist, according to the ASHA, include: Prevention: Promoting hearing wellness, hearing loss prevention, and hearing function protection. It also includes participation in noise measurements of the acoustic environment to improve accessibility and promote hearing wellness. Identification: Conducting activities designed to identify dysfunction in hearing, balance, and other auditory-related systems Supervising, implementing, and conducting follow-up of newborn and school hearing programs Screening for speech, orofacial myofunctional disorders, language, cognitive communication disorders, and/or preferred communication modalities Identifying populations and individuals who have, or are at risk for, hearing loss and other auditory dysfunction, balance impairments, tinnitus, and associated communication impairments Collaborating with speech-language pathologists to identify populations and individuals at risk for developing speech-language impairments

7 Assessment: Conducting and interpreting behavioral electroacoustic, and/or electrophysiologic methods to assess hearing, auditory function, balance, and related systems Measuring and interpreting sensory- and motor-evoked potentials, electromyography, and other electrodiagnostic tests for purposes of neurophysiologic intraoperative monitoring and cranial nerve assessment Evaluating and managing children and adults with auditory-related processing disorders Performing otoscopy for appropriate audiological management or to provide a basis for medical referral Performing cerumen management to prevent obstruction of the external ear canal and of amplification devices Preparing reports (e.g., interpreting data, summarizing findings, generating recommendations, and developing an audiologic treatment/management plan) Rehabilitation: Evaluating, selecting, fitting and dispensing technological devices (e.g., hearing aids) that help patients hear Assessing candidacy of persons with hearing loss for cochlear implants Other responsibilities include those related to advocacy and consultation, as well as those relating to education, research, and administration. In regard to certification in audiology, applicants may have chosen to apply under the 1993 or 2007 standards. The deadline for applying under the 1993 standards was December 31, 2007, after which individuals must apply under the 2007 standards. For individuals who applied for certification under the 1993 audiology standards, the requirements mandated the following: At least 27 semester credit hours in basic science course work, including: At least six semester credit hours in biological/physical sciences and mathematics At least six semester credit hours in behavioral and/or social sciences At least 15 semester credit hours in the basic human communication processes, including at least one course each in the anatomic and physiologic, the physical and psychophysical, and the linguistic and psycholinguistic bases

8 At least 36 semester credit hours in professional coursework, including: At least 30 of the 36 semester credit hours in professional course work in audiology At least 6 of the 36 semester credit hours in speech-language pathology At least 30 semester hours at the graduate level, with at least 21 of the 30 graduate hours in audiology Individuals applying under the 1993 audiology standards must have completed 375 supervised clinical observations and clinical practice, including 25 hours of observation and 350 hours of clinical practicum. Of the 350 hours of clinical practice, 250 hours must have been completed in audiology at the graduate level. Under these same standards, applicants for certification in audiology must also successfully complete the Praxis examination in audiology that is administered by the Educational Testing Service (ETS). Results of the examination must be submitted to the ASHA directly from the ETS no more than five years prior to submission of the application for certification and no less than two years after completion of academic coursework and clinical practicum. After completion of academic work, completion of a supervised clinical fellowship is required. The clinical fellowship must consist of the equivalent of 36 weeks of full-time professional experience (full-time is defined as 30 hours per week). The supervisor for the experience must hold current ASHA certification in audiology, and the clinical fellow must be assessed at least three times during the experience using the clinical fellowship skills inventory rating form. Applicants for certification under 2007 standards must complete a program of graduate study (a minimum of 75 semester credit hours) that includes academic course work and a minimum of 12 months full-time equivalent of supervised clinical practicum sufficient in depth and breadth to achieve the knowledge and skills outcomes stipulated in the ASHA s Standard IV. Supervision must be provided by individuals who hold a CCC-A in the appropriate area of practice. That program of study must address the knowledge and skills pertinent to the field of audiology. The applicant must maintain course work documentation demonstrating that the

9 requirements in this standard have been met. The minimum 75 semester credit hours may include credit earned for course work, clinical practicum, research, and/or a thesis or dissertation. Verification is accomplished by submitting an official transcript indicating that the minimum credit hours have been completed. Clinical practicum must be approved by an academic program. The applicant must maintain documentation of time spent in supervised practicum, verified by the program in accordance with Standard IV. The applicant must also pass the national examination adopted by the ASHA for purposes of certification in audiology. The organization states that summative assessment is a comprehensive examination of learning outcomes at the culmination of professional preparation. Evidence of a passing score on the ASHA-approved national examination in audiology must be submitted to the ASHA National Office by the testing agency administering the examination. The ASHA accreditation bodies (i.e., Academic Accreditation Board and Professional Services Board) do not recognize a state license in audiology as equivalent to the ASHA CCC-A, even when the standards are the same. AAO-HNS The American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) has no position statement regarding scope of service or competency requirements for audiologists. Positions of other interested parties ABA The ABA grants certification in audiology. According to the ABA, certification verifies that an individual has successfully completed a course of graduate study in audiology from a regionally accredited university, and has earned a master s or doctoral degree in audiology. Like other organizations, including the AAA and the ASHA, the ABA requires that all boardcertification applicants must have earned a doctoral degree in audiology from a regionally accredited college or university if they apply after Certificants must have achieved a score of 600 or higher on the national examination in audiology as required by the ABA. Audiologists certified by the ABA must also have demonstrated completion of a minimum of 2,000 hours of mentored professional practice in a two-year period. The mentor must be a state-licensed or ABA-certified audiologist.

10 Certification is valid for three years. Applicants for renewal must demonstrate that they have earned 45 hours of approved continuing education within the three-year period. CRC draft criteria Minimum threshold criteria for authorizing and assessing competency of audiologists References Scope of services for audiologists The following draft criteria are intended to serve solely as a starting point for the development of an institution s policy regarding this practice area. Basic education: Master s degree or AuD from an accredited university or professional school. Minimal formal training: The successful applicant must have completed a nine-month to one-year postgraduate clinical practicum experience in an accredited educational institution or its cooperating programs. The applicant must also pass a national examination in audiology or show evidence of a current CCC-A from the ASHA. In addition, the applicant must be able to demonstrate the following: Current competence and an adequate level of experience documenting the ability to provide services at an acceptable level of quality and efficiency Current active licensure to practice audiology issued by the state board of registration Documented clinical experience in providing audiology services Professional liability insurance coverage issued by a recognized company and of a type and amount equal to or greater than the limits established by the governing board A letter of reference must come from the director of the applicant s audiology training program. Alternatively, a letter of reference regarding competence may come from the head of audiology at the institution where the applicant was most recently affiliated. The typical scope of services for audiologists includes, but is not limited to, the following: Perform a wide variety of tests, including otoscopic examinations, to assess and diagnose dysfunction in hearing, auditory function, vestibular balance, and to diagnose related disorders Assess and treat patients with tinnitus using techniques such as biofeedback, masking, hearing aids, education, and counseling Present treatment options for dysfunction in hearing, auditory function, vestibular balance, and related disorders 10

11 Evaluate and fit patients for amplification and assistive listening devices Provide patients with counseling and training regarding the use of amplification and assistive listening devices Provide audiologic treatment services (e.g., clinical treatment, home intervention, family support, and case management) for infants and children Act as a member of an implant team (specializing in cochlear implants, middle ear implantable hearing aids, fully implantable hearing aids, bone-anchored hearing aids, and all other amplification/signal processing devices) that determines candidacy based on hearing and communication information Provide pre- and postimplant assessment, counseling, and all aspects of audiologic treatment, including auditory training, rehabilitation, implant programming, and maintenance of implant hardware and software Referral of patients to physicians when hearing problem needs surgical or medical attention Special requests for audiologists For each special request, threshold criteria (e.g., additional training or completion of a recognized course and experience) must be established. For more information For more information regarding this practice area, contact: American Academy of Audiology 8201 Greensboro Drive, Suite 300 McLean, VA Telephone: 703/ Fax: 703/ Web site: American Academy of Otolaryngology Head and Neck Surgery One Prince Street Alexandria, VA Telephone: 703/ Fax: 703/ Web site: 11

12 American Board of Audiology Plaza American Drive, Suite 300 Reston, VA Telephone: 800/ Fax: 703/ Web site: American Speech-Language-Hearing Association Rockville Pike Rockville, MD Telephone: 301/ or 800/ Fax: 301/ Web site: 12

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14 Privilege request form Scope of practice: Audiologist Applicants for the position of audiologist must meet the following minimum threshold criteria: Basic education: Master s degree or AuD from an accredited university or professional school. Minimum formal training: The successful applicant must have completed a nine-month to one-year postgraduate clinical practicum experience in an accredited educational institution or its cooperating programs. The applicant must also pass a national examination in audiology or show evidence of a current CCC-A from the ASHA. In addition, the applicant must be able to demonstrate the following: Current competence and an adequate level of experience documenting the ability to provide services at an acceptable level of quality and efficiency Current active licensure to practice audiology issued by the state board of registration Documented clinical experience in providing audiology services Professional liability insurance coverage issued by a recognized company and of a type and amount equal to or greater than the limits established by the governing board References: A letter of reference must come from the director of the applicant s audiology training program. Alternatively, a letter of reference regarding competence may come from the head of audiology at the institution where the applicant was most recently affiliated. Scope of services for audiologists: Typical scope of services includes, but is not limited to, the following services: Perform a wide variety of tests, including otoscopic examinations, to assess and diagnose dysfunction in hearing, auditory function, vestibular balance, and to diagnose related disorders Assess and treat patients with tinnitus using techniques such as biofeedback, masking, hearing aids, education, and counseling Present treatment options for dysfunction in hearing, auditory function, vestibular balance, and related disorders Evaluate and fit patients for amplification and assistive listening devices Provide patients with counseling and training regarding the use of amplification and assistive listening devices Provide audiologic treatment services (e.g., clinical treatment, home intervention, family support, and case management) for infants and children Act as a member of an implant team (specializing in cochlear implants, middle ear implantable hearing aids, fully implantable hearing aids, bone-anchored hearing aids, and all other amplification/signal processing devices) that determines candidacy based on hearing and communication information 14

15 Provide pre- and postimplant assessment, counseling, and all aspects of audiologic treatment, including auditory training, rehabilitation, implant programming, and maintenance of implant hardware and software Referral of patients to physicians when hearing problem needs surgical or medical attention I understand that by making this request, I am bound by the applicable bylaws or policies of the hospital, and hereby stipulate that I meet the minimum threshold criteria for this request. Practitioner s signature: Typed or printed name: Date: 15

16 Editorial Advisory Board Clinical Privilege White Papers Group Publisher: Bob Croce, Managing Editor: Todd Morrison, William J. Carbone Chief Executive Officer American Board of Physician Specialties Atlanta, GA Darrell L. Cass, MD, FACS, FAAP Codirector, Center for Fetal Surgery Texas Children s Hospital Houston, TX Jack Cox, MD Senior Vice President/Chief Quality Officer Hoag Memorial Hospital Presbyterian Newport Beach, CA Stephen H. Hochschuler, MD Cofounder and Chair Texas Back Institute Phoenix, AZ Bruce Lindsay, MD Professor of Medicine, Director, Cardiac Electrophysiology Washington University School of Medicine St. Louis, MO Beverly Pybus Senior Consultant The Greeley Company, a division of HCPro, Inc. Marblehead, MA Richard Sheff, MD Chair and Executive Director The Greeley Company, a division of HCPro, Inc. Marblehead, MA The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials committees in developing their own local approaches and policies for various credentialing issues. This information, including the materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, additional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained. Reproduction in any form outside the recipient s institution is forbidden without prior written permission. Copyright 2008 HCPro, Inc., Marblehead, MA