Designing a complex needs service

Transcription

1 Designing a complex needs service Martin O Driscoll & Shahad Howe Manchester Royal Infirmary Martin.odriscoll@cmft.nhs.uk

2 Pre AQP!

3 Project Aims:- 1.Develop and implement a specialist clinic for adults with complex hearing needs 2.Form a professional network for audiologists working with people with complex hearing problems

4 MRI Services for Adults with Complex Needs Middle Ear Implant APD Unilat HL X Hg aids BCD BCD Complex Hearing Needs Clinic Adult Hg Aids Brainstem Implant Learning Disability Cochlear Implant Hearing Therapy Current Strengths One management structure Flow of staff between different services Need to Develop A complex hearing needs service linking together the specialist services

5 Development and implementation of clinic Define the Complex Hearing Needs group Current referral rates Current treatment pathways and times to treatment Create Specialist Hearing Assessment and Rehabilitation Clinic from the subset of existing specialist services (SHARC) Develop process map for the clinic Develop referral guidelines for accessing the clinic Develop clear triage guidelines for new referrals Identify additional resources required Identify any training needs of staff Evaluate outcomes Appropriateness of referral and triage RTT time Patient satisfaction Complex Hearing Needs

6 How do we define a Complex Hearing Need? Severe / Profound HL Mixed / Conductive HL APD Learning Disability Unilateral HL Anyone who is not routine!? Additional Sensory Impairment Needs Interpreter NOHL Ski-slope HL Fluctuating HL Requires frequent follow-up ANSD

7 Referral criteria 1 Definition Explanation Fluctuating hearing loss e.g. due to Meniere s disease Ski-slope audiogram Where 50dB difference in hearing levels across octaves between 0.5 and 4kHz Unilateral /Asymmetrical HL CROS or Bi-CROS candidates Severe-profound HL Hearing levels 80dBHL at2 and 4kHz Conductive HL Normal BC results ( 20dBH L)and airbone gap 50dBHL atany frequency between 0.5 and 4kHz Mixed hearing loss AC levels are 60dBHL and the air-bone gap is 30dBHL atany frequency between 0.5 and 4kHz

8 Referral criteria 2 Definition Explanation Frequently attended for followup or fine tuning FT on more than 2 occasions Someone who has attended for FU or Suspected non-organic E.g. inconsistent or unreliable hearing loss responses, or not compliant with hearing tests. Diagnosed acoustic neuroma If hearing aid trial required Diagnosed NF2 If hearing aid trial required Suspected or diagnosed ANSD If hearing aid trial required.

9 Assessments PTA Speech testing TEN test Objective assessment OAEs Tympanometry Acoustic reflexes Visible speech mapping Management Hearing aid fitting / fine tune (with non-routine hearing aids and visible speech mapping) Onward referral to specialist services Referral to other agencies Initial appointment 1.5 hours Follow up appointment 1 hour

10 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Number of referrals Referral rate Number of referrals per month Month 380 referrals to date

11 Referral source

12 Referral reason

13 SHARC General Facts 70% = increased satisfaction compared to previous audiology experience 2 = Average number of SHARC appts before discharge back to referrer 10% = DNA rate for SHARC (18% for other audiology appts)

14 Second Aim: Form a Professional Network Northwest Complex Hearing Needs Network (NWCHNN) 8 meetings to date Covering e.g. NOHL, severe-profound fittings, BCD, complex REMs, speech testing, counselling, CROS systems, ALDs, tinnitus etc Share good practice Forum for case presentations and discussion Develop treatment pathways Develop good practice guidelines Currently 28 key-workers representing 18 departments Attend and host network meetings Communication link between departments in the region Work with and support Manchester CI, MEI, BCD and SHARC teams

15 What about AQP? AQP Referral Complex Patient Triage SHARC Clinic Complex AQP Reject AQP (RAQP) Routine AQP Complex AQP Pathway Routine AQP Pathway Complex AQP Tariff Standard AQP Tariff

16 What do we do with complex AQP patients RAQP (rejected AQP) pathway developed and agreed with commissioners. Commissioners defined complex and used our definition published in the improvement document Currently seen either within routine clinics or SHARC & standard outpatient tariff per appointment is used rather than whole treatment tariff (as used in AQP) Manchester AQP Tariff Over 18 years Tariff Routine as per AQP Routine AQP Patients Tariff from CCG Price 1 Assessment only Assessment, fitting of 1 aid, cost of 1 aid, follow-up, 3 years aftercare and 3rd year review Assessment, fitting of 2 aids, cost of 2 aids, follow-up, 3 years aftercare and 3rd year review Annual aftercare and review (after 3rd year) 23

17 Complex Definition Copies available from

18 Complex Tariff From April 2014 new tariff now agreed between Manchester Royal Infirmary and Manchester CCG for complex cases based on: Longer appointment times More specialised assessments required More frequent visits More expensive hearing aids

19 References Pushing the boundaries - Evidence to support the development and implementation of good practice in Audiology 2010 Shaping the Future: Strengthening the Evidence to Transform Audiology Services Copies available from

20 THANK YOU