Spyridakou Chrysa, Mendis Surangi, DeVal Daniel
Audiovestibular Medicine, Royal National Throat Nose and Ear Hospital, London, UK.
BMJ Open Qual. 2019 Jun 21;8(2):e000336. doi: 10.1136/bmjoq-2018-000336. eCollection 2019.
Young people with permanent hearing loss need to transition into adult services and engagement with the transition process is required to achieve this. Although there are clear national recommendations about the transition process and transfer to the adult services limited evidence has been published about the implementation and efficacy of transition programmes in young adults with permanent hearing loss. The primary aim of this quality improvement project was to significantly increase the number of teenagers with a clear transition protocol documented in their notes. The secondary aims were to ensure good medical and audiological outcomes based on all completing their medical investigations prior to transfer to the adult services and also based on a survey regarding attitudes to hearing aids use. A multiphase intervention programme was developed; (1) staff update with national transition protocols, (2) development of a clear transition protocol, (3) allocated key worker (4) access and (5) engagement. Through these interventions we increased the number of teenagers who had a clear transition protocol documented in their notes from 11% to 91%. 84% of our teenagers had completed their medical investigations, although documented discussion about the investigations had been done with 100% of the cohort. 9.2 % of adolescents felt pressurised to use hearing aids compared to 35% prior to the interventions. This project resulted in clear, measurable conclusions and we have shown that we better understand the needs of our patients and the improvement is sustainable.
患有永久性听力损失的年轻人需要向成人服务过渡,而实现这一目标需要参与过渡过程。尽管对于过渡过程以及向成人服务的转移有明确的国家建议,但关于永久性听力损失的年轻成年人过渡计划的实施和效果,发表的证据有限。这个质量改进项目的主要目标是显著增加在其病历中有明确过渡方案记录的青少年数量。次要目标是基于所有青少年在转至成人服务之前完成其医学检查,以及基于一项关于助听器使用态度的调查,确保良好的医疗和听力学结果。制定了一个多阶段干预计划;(1)工作人员更新国家过渡方案,(2)制定明确的过渡方案,(3)分配关键工作人员,(4)提供机会,(5)促进参与。通过这些干预措施,我们将病历中有明确过渡方案记录的青少年数量从11%增加到了91%。84%的青少年完成了医学检查,尽管与100%的队列进行了关于检查的记录讨论。与干预前的35%相比,9.2%的青少年感到使用助听器有压力。这个项目得出了明确、可衡量的结论,并且我们已经表明我们更好地理解了患者的需求,而且这种改进是可持续的。