Redesign of Adult Audiology Services at the Royal Liverpool Hospital

PresentedBy

Neil TurnerAudiology Services Manager

Overview

• Based in The Royal Liverpool Hospital

• Serve a catchment area of 350,000

• 15,000 patients per year

• Only one Satellite Clinic

• Began fitting Digital Hearing aids in 2003

Staffing

• 6 Full time Audiologists

• 3 Part time Audiologists

• 1 Hearing Therapist

• 2 Assistant Audiology Practitioners

• 3 A&C

The Problem

• Waiting list prior to modernisation• Over 1250 patients awaiting HA assessment or

fitting by end of 2005 = 104 weeks• Reduced by 50% by end of 2006• Mid 2007 = end of 2005• Patient Council

The Plan of Action

• 18 weeks made simple

• 6 weeks by the end of March 08

• 18 weeks by the end of 2008

• Make it sustainable

GP Referral

DR HA Fitting

18 Weeks RTT

0 Weeks 6 Weeks 18 Weeks

Working Differently

• Audiology room capacity

- 4 long days

- 9 day rota • Appropriate appointment allocation • Group hearing aid instruction appointments • Patient assessed and fitted with a hearing aid on the same

day• Overtime in the evenings and weekends• Planning Patient journey in logical order

Organisation of the NHS Aural Rehabilitation Programme

GP

2. Hearing Aid Fitting Waiting

List

3. Reassessment

Open Fit

ENT

4. Follow Up

Repairs

Open Fit

1. Direct referral

Group Instruction

Custom / Open Fit

0

20

40

60

80

100

120

Nu

mb

er o

f W

eeks

2006-1 2006-4 2007-2 2008-1 2008-2 2008-3 2008-4

Patient Waiting Lists 2006-2008

Weeks DR Weeks HAF

The Result• By the 31st March 2008 the 6 week target had been met

• Patients given an appointment to have their hearing aid fitted within the remaining 12 week slot available to us

• Regular group instruction appointments because patient feedback has been so positive

• At no time was the quality of the service offered to the patients compromised or their dignity disrespected

• A monthly progress report sent out to all the staff

• The patient council kept informed via regular meetings• The reduction in waiting times has allowed for regular staff meetings

and training sessions.• Staff are eager to pursue self development and are encouraged to

take on specific projects that will help to continue to improve the Audiology service that this Trust provides.

• Closer links with Manchester University as staff can now coordinate and mentor BSc and MSc Audiology students as they come into the profession

• Reduction in DNA’s• Working more closely with the Merseyside Society for Deaf People• Decrease in complaints• Team of the Year Finalist 2008

The Impact

Expansion of the Service

Staffing

• Review skill mix at every opportunity• Good working relationship with ENT• Wax removal on same day• Set up Audiology Bank in the Trust• Appointed times for ENT PTA’s

Proposed Extra Activity Figure 3. Current centralised audiology services and proposed support services

Current

Proposed

Non NHS

Tinnitus

Hearing Therapy

Repairs

Direct Referral

ENT

Hearing Aid Fitting

Follow Up

BROADGREEN

GARSTON

CENTRE FOR THE DEAF

R.L.H.

Group Instruction

R e p a ir se ss io ns

Em ergency repairN e e de d fo r w o rk , d ua l sen so ry

im p a irm e n t, ca re r, p ro fou n d h ea ringlo ss an d reg u la r u ser

Y e sDrop in

W h is tlin g , e arm o u ld , fe lla p a rt, ca sin g o r b a tte ry d ra w er

b roke n, n o sou ndBooked repair w ith AAP or Audiologist

I f h ave a tten de d w ith sa m e fa u lt in la st3 m o nths

Longer appointm ent neededFine tune w ith Audiologist

S o un d n ee d s a lte ring , n o th a pp y w ith sou n d , f in e tu ne

Booked repair w ith Audiologist

N o

T u b in g?

Regular repair

Expansion

• Hearing aid help group• Group Tinnitus information sessions• Adults with learning difficulties clinics • Advanced Diagnostic clinics

Summary

Why we succeeded!!

Audiologists

A&C Patient Council

The Philosophy

Tell me and I may forgetShow me and I may remember

Involve me and I will understand

Thank You For Listening