At discharge, two questions need to be answered in relation to hearing:
- Has the baby had basic hearing screening (AABR)?
- Does the baby need early or targeted audiology follow-up?
Welcome to the Right Decision Service (RDS) newsletter for September 2024.
This business case has now been endorsed by the HIS Board and will shortly be submitted to Scottish Government.
To balance increasing demand with available capacity and financial resource, the RDS team and Tactuum are now working together to implement closer management of support tickets. As a key part of this, we want to ensure clear, timely and consistent communication with yourselves as requesters.
Editors will now start seeing new messages come through in response to support ticket requests which reflect this tightening up and improvement of our processes.
Key points to note are:
2.1 Issues confirmed by the RDS and Tactuum teams as meeting the critical/urgent and high priority criteria will continue to be prioritised and dealt with immediately.
Critical/urgent issues are defined as:
Example – RDS website outage.
Please remember to email ann.wales3@nhs.scot and his.decisionsupport@nhs.scot with any critical/urgent issues in addition to raising a support ticket.
High priority issues are defined as:
Example – Build to app not working.
2.2 Support requests that are outwith the warranty period of 12 weeks since the software was originally developed will not be automatically addressed by Tactuum. The RDS team will consider these requests for costed development work and will obtain estimate of effort and cost from Tactuum for priority issues.
2.3 Support tickets for technical issues that are not classified as bugs will not be automatically addressed by Tactuum. The definition of a bug is ‘a defect in the software that is at variance with documented user requirements.’ Issues that are not bugs will also be considered for costed development work.
The majority of issues currently in support tickets fall into category 2 or 3 above, or both.
2.4 Non-urgent requests that require a deployment (i.e a new release of RDS) will normally be factored into the next scheduled release (currently end of Nov 2024 and end of Feb 2025) unless by special agreement with the RDS team.
Please note that we plan to move in the new year to a new system whereby requests all come to an RDS support portal in the first instance and are triaged from there to Tactuum when appropriate.
We will be organising a webinar in a few weeks’ time to take you through the details of the current support processes and criteria.
The next scheduled RDS deployment will take place at the end of November 2024. We are reviewing all outstanding support tickets and feature requests along with estimates of effort and cost to determine which items will be included in this deployment.
We will update you on this in the next newsletter and in the planned webinar about support ticket processes.
Many thanks to those of you who attended our recent webinar on the contingency arrangements being put in place to prevent future RDS outages as far as possible and minimise impact if they do occur. Please contact ann.wales3@nhs.scot if you would like a copy of the slides from this session.
The NES clinical knowledge pathway (CKP) publisher is now retired and the majority of pathways supported by this tool have been transferred to the RDS. Examples include:
NHS Lothian musculoskeletal pathways
NHS Fife rehabilitation musculoskeletal pathways
NHS Tayside paediatric pathways
Include:
Focus on frailty (from HIS Frailty improvement programme)
NHS GGC Money advice and support
If you would like to promote one of your new toolkits through this newsletter, please contact ann.wales3@nhs.scot
To go live imminently:
We have recently analysed the results of a survey of users of the Scottish Palliative Care Guidelines toolkit. Key findings from 61 respondents include:
Key strengths identified included:
Users highlighted key areas for improvement in terms of navigation and search functionality. The survey was very valuable in enabling us to uncover the specific issues affecting the user experience. Many of these can be addressed through content management approaches. The issues identified with search results echo other user feedback, and we are costing improvements with a view to implementation in the next RDS deployment.
This decision support software, sponsored by Scottish Government Effective Prescribing and Therapeutics Division, is now available for all primary care clinicians across NHS Tayside. Board-wide implementation is also planned for NHS Lothian, and NHS GGC, NHS Ayrshire and Arran and NHS Dumfries and Galloway have initial pilots in progress. The University of Dundee has been commissioned to evaluate impact of this decision support software on prescribing practice.
Ten bite-size (5 mins or less) video tutorials for RDS editors are now available in the “Resources for providers of RDS tools” section of the RDS. These cover core functionality including Save and preview, content page and media management, password management and much more.
10. Training sessions for new editors (also serve as refresher sessions for existing editors) will take place on the following dates:
To book a place, please contact Olivia.graham@nhs.scot, providing your name, organisation, job role, and level of experience with RDS editing (none, a little, moderate, extensive.)
If you have any questions about the content of this newsletter, please contact his.decisionsupport@nhs.scot
With kind regards
Right Decision Service team
Healthcare Improvement Scotland
All babies should have a newborn hearing screen, unless parents decline following information about it. Each baby is given up to two tests, i.e. if no clear response is obtained on the hearing screen on initial testing in one or both ears, it will be repeated at least 6 hours later to see if a clear response can be obtained on one or both ears. If a clear response is obtained on either test in both ears and the baby has NO other risk factors requiring early or targeted follow-up, the baby needs no further reviews (see patient pathway below).
The test used in NHS Lothian is the automated auditory brainstem response (AABR), which tests for conductive hearing loss as well as sensory hearing loss. It has a high sensitivity (99%) and specificity (99%). However, it is susceptible to ambient noise and may also give a false positive result in premature babies due to an immature CNS.
Most term babies are identified on day 1 and screened in hospital by the Newborn Hearing Screeners. If babies are born at home, discharged early from LDRP, or discharged over a weekend, the Hearing Screeners track them down by CHI number and recall them to an outpatient clinic organised by Paediatric Audiology which may be at RHCYP or in the community.
Some babies require early audiology referral regardless of whether they have had AABR screening or not (See Section A of Risk Factors below).
Some babies who pass the initial AABR screen will still require targeted review at 8 months (See Section B of Risk Factors below).
The patient pathway following initial AABR screening is shown.
At discharge, two questions need to be answered in relation to hearing:
It is the responsibility of medical staff discharging babies from the Neonatal Unit to ensure that the AABR has either been done or to make it clear in the discharge letter that it still needs to be done.
AABR can be performed on the ward if the baby will still be an inpatient for a few days, and babies will be identified by the Hearing Screeners during weekdays. If the baby is discharged to the ward at the weekend and then goes home in the same weekend, the Hearing Screeners track them down by CHI number and recall them to Paediatric Audiology.
Please make it clear on the transfer letter whether the baby has had the initial AABR screen or not (premature infants usually only get it done before discharge home).
Please also make it clear to the receiving hospital whether or not the baby has risk factors requiring audiology follow-up.
With discharge planning, all ex-prems should have had the AABR done prior to discharge. Medical staff should help with obtaining consent for these babies as parents are not often in when the Hearing Screeners are around.
Term babies discharged directly home from the Neonatal Unit should have the AABR done at some point during their stay, unless their entire stay was over a weekend.
Medical staff doing the discharge letter need to highlight whether or not the baby has risk factors requiring audiology follow-up.
All babies who have risk factors requiring audiology referral should be referred to Paediatric Audiology for diagnostic assessment using the ‘Ward Referral to Paediatric Audiology’ referral form. If risk factors are identified please fill in the form and email a copy to Paediatric Audiology at audiology.rhcyp@nhslothian.scot.nhs.uk. For any urgent referrals please also copy in the UNHS manager Erin Moffat on erin.moffat2@nhslothian.scot.nhs.uk.
Risk factors requiring audiology follow-up1
A. Early audiology referral (these babies should be referred immediately to Paediatric Audiology on discharge from the Neonatal Unit regardless of whether or not AABR screening has been performed)
B. Babies requiring targeted review at 8 months, even if AABR screening is passed
C. If AABR is passed but the baby then develops any of the following, refer immediately to Paediatric Audiology for reassessment (this section is for babies who may have returned to the Neonatal Unit or Clinics after discharge from the wards)
1. Public Health England. 2019. Guidelines for surveillance and audiological referral for infants and children following newborn hearing screening. [online] Available at: https://www.gov.uk/government/publications/surveillance-and-audiological-referral-guidelines