Inpatient Audiograms: A Mixed Methods Study Examining Clinical Decision Making, Financial Analyses, and Audiologist Perspectives.

OBJECTIVE

Evaluate inpatient audiometry on clinical decision-making. Assess stakeholder perspectives on the practice of inpatient audiometry and financial impact.

STUDY DESIGN

This is a mixed methods study utilizing retrospective chart review, a focus group, and financial analyses.

SETTING

Academic tertiary referral center.

METHODS

Included subjects were adults (18+) admitted from 2015 to 2022 who received an inpatient audiogram (n = 302). A binary assessment of whether audiograms impacted inpatient clinical management was determined. Financial analyses estimated the cost of audiograms. An audiology focus group was conducted.

RESULTS

The average age was 51 years. Thirty-nine percent were female. Seventy percent of inpatient audiograms were associated with Otolaryngology consultation. Inpatient audiograms were performed an average of 3.6 days after request (0-47 days, 90th percentile 8.2 days). Forty-nine percent were performed within 1 day. Twenty-three percent were performed for acute hearing loss. Ototoxic monitoring was the most frequent indication (15%). Sixty-two percent of audiograms did not impact the initiation or withholding of treatment. Inpatient testing results in a 63% increase in cost over outpatient. Audiologists endorsed challenges with equipment, patient-level factors, and system-level challenges.

CONCLUSION

Inpatient audiometry is resource-intensive without significant data examining the impact and clinical utility. In most cases, inpatient audiometry is not used in the decision to withhold or deliver treatment and may cost 63% more than outpatient audiograms. While inpatient audiometry has a critical role in appropriate settings, system optimization and guidelines are necessary. Outpatient audiograms may suffice for the majority of otologic consults in combination with a thorough history and physical exam. Additional study across institutions with variable practice would be beneficial to establish broader recommendations.