PP401 - Consistency in Follow-Up Recommendations in Pediatric Behavioral Testing

Abstract:
It is generally accepted that ear-specific behavioral audiologic testing is the gold standard in pediatric hearing assessment.  However, for many young children, multiple visits for behavioral and physiologic testing may be needed to obtain complete information. Limited information exists that names specific time frames for behavioral follow-up visits. Further, AuD students often struggle with understanding the interrelated factors that influence the recommended time for follow-up visits.  This poster describes the development and implementation of a Pediatric Follow-up Recommendation Flowchart, as a teaching tool for students as well as for use in the clinic for pediatric audiologists.<

Summary:
It is generally accepted that behavioral audiological testing is the gold standard in pediatric hearing assessment. Further, behavioral testing aims to obtain ear-specific thresholds across the frequency spectrum and when possible, speech perception measures (AAA, 2020). The Ohio Pediatric Behavioral Diagnostic Recommendations (2020) state that complete assessment for hearing diagnosis includes: 4-frequency, ear-specific minimal response levels (MRLs), speech thresholds and tympanometry, utilizing acoustic reflexes and OAEs for cross-check validity purposes (Baldwin et al., 2010). However, for many young children, multiple visits for behavioral and physiologic testing may be needed to obtain complete information particularly when young children may be resistant to wearing ear specific phones.  Limited information exists which specifies the time frame of follow-up visits. The diagnostic process must take place as quickly as possible for appropriate early intervention to begin. Scheduling period for additional visits may vary depending on reason for referral, hearing risk factors and data obtained in the first testing appointment. It was seen in our clinic that audiology students often struggle with understanding the recommended time frame for follow-up for continued behavioral testing when complete information was not obtained at the first visit.

A team of pediatric audiologists reviewed current behavioral audiometric test guidelines and practice.  A teaching tool was developed and implemented to aid in teaching students when to recommend follow-up testing. This tool is based on the patient’s presenting diagnosis, referral reason, hearing risk factors and test data. The resulting Pediatric Follow-up Recommendation Flowchart incorporates behavioral and physiologic test data as well as level of concern for hearing loss and specification of time frame for continued testing. The Flowchart has improved student understanding of the follow up recommendation process and supplied a consistent guideline for scheduled appointments.
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To evaluate scholarship of teaching and learning using this tool, 5 AuD externs who were scheduled for a pediatric rotation were asked to complete a pre-test with examples of clinical scenarios in which a follow-up behavioral evaluation is needed. Following a 30-minute instruction period with the tool, a post-test will be given where students are asked to recommend a time frame for continued testing. Results will be shared in this presentation.

To further evaluate the effectiveness of this guideline in clinical practice, a quality review of thirty charts is in the process to determine consistency of recommendations by pediatric audiologists in our practice.  All data from AuD students and chart reviews will be collected prior to February 1, 2024, and results will be shared.

This poster will include the Flowchart and discuss how it has been implemented in patient care and teaching students to make recommendations for follow-up testing. This presentation includes take home materials attendees may use in their own practice.