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Designing a complex needs service

Designing a complex needs service. Shahad Howe Manchester Royal Infirmary shahad.howe@cmft.nhs.uk. Cambridge severe-profound study day Dec 2013. Current Strengths One management structure Flow of staff between different services Need to Develop

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Designing a complex needs service

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  1. Designing a complex needs service Shahad Howe Manchester Royal Infirmary shahad.howe@cmft.nhs.uk Cambridge severe-profound study day Dec 2013

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

  3. Development and implementation of clinic Define the ‘Complex Hearing Needs’ group Current referral rates Current treatment pathways and times to treatment Current specialist services 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 benefit and satisfaction Complex Hearing Needs

  4. How do we define a ‘Complex Hearing Need’? Severe / Profound HL APD Learning Disability Anyone who is not routine!? Mixed / Conductive HL Needs Interpreter Unilateral HL NOHL Additional Sensory Impairment Requires frequent follow-up Ski-slope HL Fluctuating HL Auditory Neuropathy /De-synchrony

  5. Referral criteria

  6. Referral criteria

  7. 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

  8. Severe-profound patients • Hearing reassessment • Unaided and aided • Speech testing • Consider dead regions • Hearing aid optimisation • Consider non-conventional hearing aids and signal processing • Consider non-routine earmould types • Screening for cochlear implant suitability • Annual review

  9. Referral rate N = 276

  10. Referral source N = 276

  11. Referral reason N = 276

  12. RTT

  13. NWCHNN Northwest Complex Hearing Needs Network 8 meetings to date Covering e.g. NOHL, severe-profound fittings, complex REMs, speech testing, counselling, CROS systems, ALDs 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, BAHA and SHARC teams

  14. Innovation Productivity Quality More clearly defined pathway and continuity of care for patients 66% of patients reported increased level of satisfaction (compared with previous experience) Introduction of designated clinic for patient group Collaboration of secondary and tertiary providers through network Increased referrals for appropriate treatment at appropriate time with potential positive impact on cost efficiency and waiting times Benefits - QIPP

  15. What do we do with ‘complex’ patients on AQP pathway? • May require more time and resources • RAQP (rejected AQP) pathway developed and agreed with commissioners to use SHARC referral criteria to define ‘complex’ • Currently seen within routine clinics but standard outpatient tariff per appointment is used rather than whole treatment tariff (as used in AQP) • Manchester AQP Tariff

  16. ‘Complex’ Tariff • Further discussions around more appropriate treatment tariff is currently taking place: • May require more time and resources • More specialised assessments required • More frequent visits • More expensive hearing aids fitted

  17. 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 http://www.improvement.nhs.uk/audiology/resources.html

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