Level 1 Triage Your Name Your Service

1. Level 1 TriageYour NameYour Service

2. Triage Guidelines Are For All Providers • Patients report tinnitus to healthcare providers in many different clinics—besides Audiology • Otolaryngology • Primary Care • Psychology • Psychiatry • Neurology • Oncology • Pain Clinic and other clinics • The triage level applies to all clinicians who encounter patients who complain about tinnitus

3. Triaging Patients Who Complain of Tinnitus • At the triage level, there normally are four possibilities for needed referrals: • Emergency triage—Urgent Care or ENT • Mental Health • ENT • Audiology • Tinnitus Triage Guidelines should be distributed to clinics that are likely to encounter patients who complain about tinnitus

4. Tinnitus Triage Guidelines (My Patient Complains About Tinnitus—What Should I Do?)

6. “A Triage Guide for Tinnitus” • Henry JA, Zaugg TL, Myers PJ, Kendall CJ, Michaelides EM. A triage guide for tinnitus. The Journal of Family Practice 59(7):389-393, 2010.

7. Suggestions for Triage Guide Distribution • Contact your referring providers to set up a brief in-service to discuss the triage guidelines and tinnitus management services offered by your service • Discuss and provide referral contacts with a copy of “A Triage Guide for Tinnitus” article and Triage Guidelines • These guidelines could be written into your participating Service Agreements if warranted

8. In-service Suggestions to the Referral Sources Depending on time allotted at the in-service: • Distribute and discuss Triage Guidelines • Distribute article “A Triage Guide for Tinnitus” and discuss TMS CEU/CME PTM online module(s) 1-3 particularly • Discuss the PTM Services audiology provides • Provide additional Tinnitus / PTM references to learn more

9. Key Points Level 1 Triage In-Service • Spotlight the problem of tinnitus to VA • Explain the referral providers’ important role in triaging their patients who self reports problematic tinnitus • Explain your (the audiologist) role in providing PTM • Provide informational handouts and reference sources to learn more

10. Magnitude Of the ProblemTinnitus

11. What Do We See in VA Audiology Clinics? Increased Claims for Tinnitus & Hearing Loss Disability Help us PREVENT it! American Tinnitus Association

12. Tinnitus is #1 – unfortunately • Most common individual disability (744,871 Veterans) for all Veterans receiving disability payments in FY 2010 • Also, most common disability among Veterans who began receiving benefits during FY 2010 (92,260 Veterans – 10.7% of all new disability awards)

13. Veterans Service-Connected for Tinnitus Source: Veterans Benefits Administration, VHA Support Service Center

14. JAHVA Forum 2006 Year in Review James A Haley VA Newsletter 33 yo Marine vividly recalls the incident that took both his legs while on combat patrol led by members of the Iraqi Army. “It was surreal. The blast was so loud I couldn’t hear anything except for the ringing in my ears.My legs were literally blown off below my knee-I saw them lying on the road about 30 feet away from me.”

15. Former Staff Sgt. Ryan Kelly, 27, still carries the sounds of war with him even four years after his return home. He experienced the concussive force of three IEDs exploding simultaneously in Baghdad. “It’s funny, you know. When it happened,” Kelly explained, “I didn’t feel my leg gone. [Kelly lost his leg below the knee] What I remember is my ears ringing.Today, Staff Sgt. Kelly wears a prosthetic leg, but the ringing in his ears [tinnitus] is still present. War Vets: Heroes and Hearing 7/4/2008 HealthyHearing

16. War Vets: Heroes and Hearing (con’t)7/4/2008 www.healthyhearing.com “It is constantly there,” Sgt. Kelly said. “It constantly reminds me of getting hit. I don’t want to sit here and think about getting blown up all the time but that’s what it does.”It is a condition that has no cure or even many treatment options. Distraction techniques help those with tinnitus hear “through” the ringing in the ears, but the effectiveness of this therapy has yet to be confirmed sufficiently.

17. We Offer a Progressive Approach to Tinnitus Management

18. YOUR role in PTM Triage Patients who Self Report Problematic Tinnitus to Appropriate Clinic(s)

20. Tinnitus Triage Guidelines (My Patient Complains About Tinnitus—What Should I Do?)

21. To Learn More: PTM Broadcast on CDN CDN links for the PTM broadcast to watch on your desktop,--each part is 30 minutes Part 1:  http://vaww.vakncdn.lrn.va.gov/cl_popup.asp?mode=popup&Media_ID=3658&M_Cat_ID=24 Part 2:  http://vaww.vakncdn.lrn.va.gov/cl_popup.asp?mode=popup&Media_ID=3659&M_Cat_ID=24 Part 3:  http://vaww.vakncdn.lrn.va.gov/cl_popup.asp?mode=popup&Media_ID=3660&M_Cat_ID=24

22. TMS Online Module(s) Available to Learn More

23. TMS PTM On-Line Modules

24. To Learn More about the PTM Protocol Created for VAhttp://www.va.gov/health/NewsFeatures/20110524a.asp

25. http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asphttp://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/Index.asp

26. ConclusionOur VA Commitment to PTM • PTM research commitment from Central Office, NCRAR, VA RR&D grants, and clinical commitment from VA Audiologists across the nation • PTM research findings are annually spotlighted in conferences and publications