2. Development of the Quality Standards for Paediatric Audiology Services
2.1 Introduction to Paediatric Audiology Services
The prevalence of permanent childhood hearing impairment, greater than 40d BHL in the better ear, is estimated to be 1.33/1000 live births in children age 5 years and older, possibly rising to 2.05/1000 live births for children aged 9 years and older. The yield from newborn hearing screening programmes is approximately 1/1000 live births.
Childhood conductive hearing impairment is a far commoner condition. It is reported that approximately 80% of children will have had at least one episode of otitis media by the age of 3.
It is well documented that permanent childhood hearing impairment can have a significant negative impact on a child's communication skills, social integration and educational progress.
The impact of fluctuating conductive hearing losses on a child's communication skills and educational progress are less clear. There is evidence that persistent otitis media with effusion associated with a mild to moderate hearing loss can have an adverse effect on early language development and longer term effects on both behaviour and quality of life.
It is important that children with permanent childhood hearing impairment and children with persisting or recurring conductive hearing losses are identified early in order to provide the children and their families with appropriate intervention, support and advice.
The increasing prevalence of permanent hearing impairment throughout childhood, and the fluctuating nature of many conductive hearing losses, means that paediatric audiology services must have the capacity and appropriate skills, not only to identify and manage children referred from the newborn hearing screen, but also to be able to offer timely assessments and appropriate management of confirmed permanent or temporary hearing deficits whenever there are concerns raised about a child's hearing status.
Paediatric audiology services are generally multidisciplinary and may include:
- audiovestibular physicians
- audiological paediatricians
- speech and language therapists
- education staff
- social services and
- voluntary organisations
Across the United Kingdom paediatric audiology services are delivered by many differing combinations of skill mix. This is historically due to different local service models, rapid technological progress and emphasis on consumer led, family friendly services. There are also well recognised difficulties with recruitment and training in some professional groups, and in some geographical areas. Some audiological skills are common to all members of the team, but each discipline brings unique skills and expertise, all of which are necessary if services are to comply with accepted best practice.
It is important that individual paediatric audiology teams, irrespective of their service model, aspire to deliver the best possible audiology care for children and their families. They must also know the minimum acceptable standards of care that children and their families can expect to receive on their journey through paediatric audiology services.
2.2 Development and Scope of the Standards
This document covers all aspects of the paediatric audiology services delivered by health service staff and acknowledges the important role of education, social services and the voluntary sector within the multidisciplinary team; it aims to establish quality assurance throughout all aspects of the paediatric audiology process for children and their families, regardless of where the service is delivered.
Development of these Standards in Paediatric Audiology began in 2005 when a multidisciplinary group of health professionals working in paediatric Audiology, in partnership with the voluntary sector, met to identify key critical areas for clinical standards.
The standards are applicable to children of all ages, from birth to school leaving, and incorporate the audiology services provided at primary, secondary and tertiary level. They are based on the child and family's journey as they move through the paediatric audiology service. For the purposes of this document "parent" is defined as any person who has parental responsibility.
The standards are evidence based and make reference to other recognised standards, clinical guidelines and best practice documents, which must be considered alongside these standards. (see appendix 3)
Paediatric audiology services will regularly self-assess their performance against the standards using the Quality Rating Tool to help identify any possible areas of weakness and highlight strengths and areas of good practice within the local audiology service. In Scotland, overseeing the assessment of performance against the Standards will be the responsibility of the Audiology Services Advisory Group with a clearly defined assessment process and cycle.
The standards will be reviewed by ASAG 2 years post-implementation and thereafter a regular review cycle established. This will take into account ongoing developments in paediatric audiology and the emergence of new evidence to ensure that they remain relevant and up to date.
These standards are designed to improve service quality issues in clinical areas unique to Audiology within the NHS: elements of service quality such as cleanliness of facilities or workforce development are outside of the scope of this work as they are expected to be addressed by local healthcare governance mechanisms and/or more generic NHS standards.
Although the standards apply to NHS Audiology, the hope is that their implementation will encourage and further develop collaborative working, both with fellow NHS professionals and external agencies.
In addition, awareness of and compliance with statutory requirements, such as the Disability Discrimination Act 2005, is assumed, as is awareness and understanding of consent requirements.
It would be impossible to exhaustively list the many and varied service user groups who access paediatric Audiology services. It is intended that these standards apply to all children and families using the service.