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Vision and Hearing Screening

Vision and Hearing Screening. Broadway ACN PDSA 2007-2008. AIM statement. Ensure effective and proper screening of hearing and vision of 95 % of children age 4-18 years in accordance with AAP guidelines. Ensure proper referrals of 95 % of children who require them.

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Vision and Hearing Screening

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  1. Vision and HearingScreening Broadway ACN PDSA 2007-2008

  2. AIM statement • Ensure effective and proper screening of hearing and vision of 95% of children age 4-18 years in accordance with AAP guidelines. • Ensure proper referrals of 95% of children who require them. • Ensure pre-screening of 75% of patients • Decrease visit cycle time by 15%

  3. Why hearing and vision? • Vision disorders: • 4th most common disability among US children • Leading cause of childhood impairment conditions • Only 21% of all preschool children are screened • Only 14% receive a comprehensive vision exam • Hearing loss: • Most common congenital condition in the US - 33 infants born daily • Congenital deficit may only become evident in childhood • Can be acquired during infancy or childhood • Post trauma to the CNS, noise pollution, ototoxic drugs

  4. Guidelines

  5. American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine. Recommendations for preventive pediatric health care. Pediatrics.2000; 105 :645 –646

  6. AAP Guidelines: When do I screen? S: Subjective screen at every routine visit (i.e.: history) O: Objective testing

  7. Referral • Vision: • 3-5 yo: 20/50 or worse (repeat in 6 months if uncooperative) • 6 yo and older: 20/40 or worse • Any age with two-line difference between eyes, even within the passing range (i.e., 10/12.5 and 10/20 or 20/25 and 20/40) • Hearing: • Air conduction hearing threshold levels of >20 dB at any of these frequencies • 4 yo onward: each ear tested at 500, 1000, 2000, and 4000 Hz.

  8. PDSA Cycles

  9. Baseline measurementsBrooke Davey • Average visit time: 3 hours 4 minutes • Appropriately screened: • Vision: 91% (39/43) • Hearing: 91% (39/43) • Abnormal results referred: • Vision: 25% • Hearing: N/A (no abnormal screens)

  10. DidacticStephanie Marion

  11. Didactic cycleA.k.a Eclipsys crash cycle, Tom Hooven • Appropriately screened : • Vision: 94% (17/18) • Hearing: 91% • Abnormal results referred: • Vision: 25% (1/4) • Hearing: N/A (no abnormal screens)

  12. Tom Hooven cycle • What: provider pre-ordering hearing and vision in Eclipsys the day before patient comes for appointment • Who: one patient and one provider • Result: did not work as “pending return visit” orders not monitored by MAs

  13. Eclypsis

  14. Katie McGuinn cycleNovember-December • What: Effective identifying of patients in need for pre-screening: • Identification of eligible patients by providers, marked on tallies for PFAs to see • Eclipsys orders entered • Pink box on cover sheet attached to front of chart for MAs to recognize • Who: Resident clinic (half a day) • Result: Did not work – Labor intensive • Appropriately PRE-screened : • Vision: 40% (4/10) • Hearing: 60% (6/10)

  15. Erik Jensen cycleJanuary • What: • Eliminated need for provider and PFA involvement • Established age-based guidelines as to which patients would be pre-screened: • Vision: Any pt 4-18 years in clinic for regular appointment (no walk-ins) unless pt/guardian admits to testing within past 6 months. • Hearing: Any pt 4-10 years in clinic for regular appointment (no walk-ins) unless pt/guardian admits to testing within past 6 months • Who: Resident clinic (2 half days) • Results: Improved results but not at goal yet • Appropriately PRE-screened: • Vision: 67% (4/6) • Hearing: 67% (4/6)

  16. Meg Sullivan cycleFebruary • What: • Signs placed in MA’s office • Signs for provider offices and consultation • 4 day retrospective analysis • Who: All providers • Results: Confirmation of improvement • Appropriately PRE-screened: • Vision: 84% (43/51) • Hearing: 84% (43/51)

  17. Emily Kaufman final chart reviewApril – over 2 weeks, all providers • n = 72 • Average visit time: 2 hours 29 minutes • Appropriately screened: • Vision: 89% (64/72); 98.5% pre-screened • Hearing: 84% (36/43); 97% pre-screened • Abnormal results referred: • Vision: 70% (18/26) • Hearing: 0% (0/1)

  18. Summary

  19. Future Plans • Staff education planned with Ophthalmologist Michael Chiang M.D. to review vision screening methods • Find ways to decrease cycle time even more (i.e.: redesign, pairing M.A with provider, etc) • Ensure that providers are actually looking at results of screen by importing flow sheet into note

  20. Chart review of past projects • Domestic Violence at Newborn, 1 y.o. visits (2006-2007): • 45% screening (7/16; 6/10 of newborns screened and only 1/6 of 1 yo) • Blood pressure documentation (2005-2006): • 73% of charts (32/44) • Screen time documentation (2004-2005): • 0% (0/32) • BMI (5yo-19yo): • 14/34 with elevated BMI, 50% documentedintervention

  21. Thank you • PFAs: • Evelyn, Kenya, Carlos, Conchita • R.Ns: • Haydee, Catherine, Bridget, Sally • M.Ds/N.Ps: • Mariellen Lane, Pran Saha, Laura Robbins-Milne, Renie Eis, Heidi Beutler, Nan Salamon, John Rausch

  22. Thank you • The ACN Broadway residenCE: • Katie McGuinn, Brooke Davey, Stephanie Marion • Lindsey Tilt, Cyril Sahyoun, Taryn Wiley-Rio • Sangita Patel, Meg Sullivan, Jennifer Louis-Jacques • Emily Kaufman, Deena Blanchard, Tom Hooven • Eva Cheung, Emily Rothbaum, Erik Jensen

  23. Angela Celia Marilyn Felipe

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