NHSP: review of case of PCHI not identified by the newborn hearing
screen
Version
Owner
Last modified
Audience
3
Sally Wood, NHSP Clinical Advisor
08/02/16
NHSP Screening Managers, Team Leaders,
Audiologists, Medical Contacts, NHSP
Programme Centre
Contents
Section A: Background and guidance .............................................................. 1
Section B1: General Information …………………………………………………...3
Section B2: Screening episode........................................................................ 3
Section B3: Referral pathway that led to identification of hearing loss…………6
Section A: Background and guidance
Newborn Hearing Screening Programmes and associated audiology services must have a
local process in place to review any cases of moderate to profound PCHI that were not
identified by newborn hearing screening. A local named individual (preferably a senior
clinician in paediatric audiology) should be responsibility for coordinating this review and
acting on any issues identified, and will liaise closely with the local NHSP Clinical Lead(s)
and Screening Managers. Such a review will help to maintain confidence in the performance
of the hearing screening programme as well as identifying any issues with performance of
the screening programme and/or referral pathways.
Which cases should be reviewed?
Any child
 with a moderate or worse PCHI in one or both ears and
 born in England or was otherwise eligible for newborn hearing screening in England
and
 born after 1 April 2006 (the date NHSP became universal in England)
Update of eSP record
These children should have a record in eSP. You may need to carry out a national search
using the NHS number to locate the record. Transfer/share the record (if it not already in
your site) and update it.
Carrying out the review and documenting the outcome.
This document can be used to record the outcome of such a local review. It can also serve
as a report to the NHSP Programme Centre for appropriate cases.
Public Health England leads the NHS Screening Programmes
1
Purpose and aims of the review
The aims are to answer the following
1. For the screening episode
a. Was the child eligible and was screening offered?
If so, was screening carried out in accordance with NHSP protocols?
Do archived screening test results agree with the results recorded in eSP?
2. Where screening resulted in a referral
a. Was a referral made to audiology and appointments offered?
Was the diagnostic (ABR and/or OAE) assessment carried out and interpreted
in accordance with NHSP guidelines?
3. Where the screening outcome was “clear response-targeted follow up”
a. Was a referral made to audiology and appointments offered?
Was an appropriate assessment carried out?
4. Did any subsequent concerns, particularly for children that “passed” the newborn
hearing screen, lead to timely referral into audiological assessment?
Note: It is not the aim of such a review, nor is it possible, to retrospectively assess whether
the screening test gave a “correct” result. In most cases it is impossible to know for certain
whether the hearing loss was present at the time of the screen and thus whether the
screening test was “correct” or not.
Incident reporting
Report any cases where the review identifies that correct protocols were not followed or
referrals not made as incidents.
Which cases must be notified the Programme centre?
Not all cases need to be notified. Only the following cases require a separate notification to
the Programme Centre:1. PCHI >=40 dB in both ears and passed the screen (unless there is robust
evidence of meningitis or some other causative agent that occurred
subsequent to the screen in which case a separate notification is not required)
2. PCHI >=40 dB in both ears and failed the screen and initial diagnostic ABR
reported as satisfactory
If notification is required email the completed form as a password protected Word doc to
PHE screening helpdesk (Note-do not use the name or NHS number as a file name and do
not include any patient identifiers e.g. in copies of screen results)
2
Section B1: General information
Date review completed
Clinician name
1. Child details
Patient Confidential id (from eSP) 1
d.o.b.
Screening protocol (NICU/Well
baby)
2. Site and reporting clinician details
Site name
Name
Designation
Address 1
Address 2
Address 3
Telephone
E mail: please print clearly
3. Most recent hearing status
Right ear
Left ear
PCHI of any
YES/NO/NK
YES/NO/NK
degree
Average hearing
level (0.5,1,2,4
kHz)
* use this column if sound field results only are available
KEY : NK=not known,; NA= not applicable
Better ear*
YES/NO/NA
4. Audiological and management information: Please confirm
that the following information (where applicable) has been
entered in eSP
Yes/NA
Appointment details and test results for all audiological assessment
appointments
Most recent assessment summary shows degree, type and category
of hearing loss for each ear
Key dates entered-Date of confirmation of hearing loss, date aid
offered, agreed, Date referral to ToD
Amplification and cochlear implant details (if applicable)
1
Please include this for all records. Programme Centre staff are unable to view NHS numbers in eSP.
3
Section B2: screening episode
1. Screening information. Please give the screening test results under a) well baby or b)
NICU protocol as appropriate.
Ask the screening manager for the site that carried out the newborn screen to verify that the
results shown in eSP are in agreement with the results archived directly from the screening
machine.
If the results are ”clear response” please ask the screening manager to provide you with a
copy of the results. Copies are not required for incomplete or “no clear response” results.
1a) Well baby protocol
date
NHSP
site
AOAE 1
AOAE 2
AABR
1 b) NICU protocol
date
NHSP
site
Right ear
result
Left ear
result
Results
verified
Results
attached
Right ear
result
Left ear
result
Results
verified
Results
attached
AOAE
AABR
1c) Final screening outcome (tick which ever applies)
Clear response-no follow up
Incomplete-equipment
malfunction
Clear response-targeted follow up**
incomplete-appointments missed
No clear response-unilateral refer
incomplete-decline
No clear response-bilateral refer
incomplete-withdrew consent
Incomplete-screening
incomplete-out of coverage
contraindicated
Incomplete-baby unsettled
incomplete-lost contact
Incomplete-equipment not available
incomplete-lack of capacity
1d) **Reason(s) for targeted follow up (if
applicable)
1e) If the screening resulted in an immediate refer please summarise the
results of the initial diagnostic assessments and attach copies of the
diagnostic test results
Enlarge box as required
1f) If the screening resulted in a referral for targeted follow up please
summarise the results of the targeted follow up
Enlarge box as required
4
2. Summary and conclusion re screening episode
Eligible for NHSP screen i.e. born in England or moved into England
by age 3m
If eligible, screen offered
If eligible, screen completed
If screen pass, archived results cross checked and verified as being in
agreement with results in eSP
The screening episode was satisfactory i.e. screening was offered
and carried out within the required timescale, the number of screening
tests/attempts did not exceed the permitted number, the results were
correctly documented in eSP and the correct screening outcome was
set. If NO give details and lessons learned below and report as an
incident.
YES/NO/NA
YES/NO/NA
YES/NO/NA
YES/NO/NA
YES/NO/NA
Enlarge box as required
3. Summary and conclusion re immediate follow up (if screen refer)
Referral to audiology within appropriate time scale
Appointed in audiology within appropriate time scale
Attended audiology within appropriate time scale
If non-attendance were appropriate efforts made to secure attendance
and relevant professionals informed
If attended have the results of the audiological assessment been
reviewed
The screen referral was initiated and carried out and the diagnostic
test results have been reviewed and are satisfactory. If NO give
details and lessons learned below and report as an incident.
YES/NO/NA
YES/NO/NA
YES/NO/NA
YES/NO/NA
YES/NO/NA
YES/NO/NA
Enlarge box as required
4. Summary and conclusion re targeted follow up (if screen outcome=clear
response-targeted follow up)
YES/NO/NA
Referral to audiology within appropriate time scale
YES/NO/NA
Appointed in audiology within appropriate time scale
YES/NO/NA
Attended audiology within appropriate time scale
If non-attendance were appropriate efforts made to secure attendance YES/NO/NA
and relevant professionals informed
YES/NO/NA
If attended have the results of the audiological assessment been
reviewed
YES/NO/NA
The targeted follow up referral was initiated and carried out and the
diagnostic test results have been reviewed and are satisfactory. If NO
give details and lessons learned below and report as an incident.
Enlarge box as required
5
Section B3: referral pathway that led to identification of hearing
loss
1. Referral details. Please complete the following details in respect of the referral
that led to the identification of hearing loss
Referral date
Referral source e.g. HV, parent,
Referral reason
2. Clinical history and timelines Please summarise the timelines from referral to
identification. Include any relevant clinical history including risk factors, aetiological
investigations and parental opinion about the duration/onset of the hearing loss.
Enlarge box as required
3. Conclusion re identification of concern, referral and diagnostic process.
There was timely referral after identification of concern, audiological assessment was
offered promptly and assessment was completed within a reasonable timeframe.
YES/NO/NA.
If NO please give details and lessons learned below.
Enlarge box as required
6