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
• 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
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