Diagnostic Testing Procedures in Audiology V2.0 1st May 2015

Diagnostic Testing Procedures in Audiology

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Table of Contents 1.

Introduction ................................................................................................................... 2

2.

Purpose of this Policy ................................................................................................... 2

3.

Scope ........................................................................................................................... 2

4.

Definitions / Glossary .................................................................................................... 2

5.

Ownership and Responsibilities (Duties) ...................................................................... 2 5.2.

Role of the Managers ............................................................................................ 2

5.3.

Role of the Audiology Team Leaders Group ......... Error! Bookmark not defined.

5.4.

Role of Individual Staff ........................................................................................... 3

6.

Standards and Practice ................................................................................................ 4 6.1.

Content .................................................................................................................. 4

6.2.

Diagnostic tests provided by the service ............................................................... 4

6.3.

How diagnostic testing procedures are risk assessed ........................................... 4

6.6. Measures that need to be in place for the diagnostic test to enable any preparation of the patient ................................................................................................. 4 6.7. Identifying the process for ensuring that informed consent is obtained prior to a diagnostic test .................................................................................................................. 4 6.8.

How the diagnostic test is requested ..................................................................... 4

6.12. How the clinician treating the patient is informed of the result, including timescales ........................................................................................................................ 5 6.18.

How the patient is informed of the result, including timescales .......................... 5

6.24.

Actions to be taken by the clinician, including timescales .................................. 6

6.29.

How the minimum requirements are recorded ................................................... 6

7.

Dissemination and Implementation (including education & training) ............................. 7

8.

Monitoring compliance and effectiveness ..................................................................... 7

9.

Updating and Review.................................................................................................... 7

10.

Equality and Diversity ................................................................................................ 8

10.2.

Equality Impact Assessment .............................................................................. 8

Appendix 1. Governance Information .................................................................................. 9 Appendix 2.Initial Equality Impact Assessment Screening Form ....................................... 11

1. Introduction 1.1. Diagnostic testing information supports many clinical decisions both in the identification of new conditions and the monitoring and treatment of existing ones. As such it sits within the overall patient clinical pathway. 1.2. The diagnostic pathway begins when a test is indicated such that a request is generated, progresses via the diagnostic process and ends when a report is received by the requester and acted upon, or when treatment is commenced within Audiology. 1.3. Failures at any point in this pathway may lead to delays in the care of the patient, sometimes with serious clinical consequences.

2. Purpose of this Policy 2.1. This policy sets out an approved documented process whereby the risks associated with diagnostic testing procedures within Audiology are managed through the provision of local policies and procedures which are implemented and monitored. 2.2. It has been developed to ensure these risks are minimised and give assurance to external bodies e.g.NHSLA. 2.3. No patient’s treatment should be delayed because of delays in the availability of Diagnostic information and the objective of this document is to ensure that this does not happen, recognising that communication problems are often the root of such delays 2.4. There is an absolute need for clear pathways that identify how, when and to whom the results should be communicated. This policy is aimed at those who provide and those who use the Audiology service.

3. Scope This policy applies to all those who request Audiology diagnostic tests and those who receive, process or need to act on the results of these.

4. Definitions / Glossary       

NHSLA: National Health Service Litigation Authority Auditbase: Audiology patient management system GP: General Practitioner PAS: Patient Administration System PTA: Pure Tone Audiogram RCHT: Royal Cornwall Hospitals NHS Trust RTT: Referral to Treatment Times

5. Ownership and Responsibilities (Duties) 5.1. The strategic and operational roles responsible for the development, management and implementation of the policy are shown below.

5.2. Role of the Managers Line managers are responsible for:

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

Conducting stringent recruitment checks to ensure that only appropriately qualified and registered staff undertake and authorise test results. Ongoing annual checks of professional registration and mandatory training.



Ongoing checks of Training & competence to perform those tests within the scope of activity of individual staff.



Ensuring that staff follow those processes and procedures described in the Standards and Practice section relevant to the part they play in the diagnostic pathway.



Producing monitoring reports to be reviewed annually at ENT audit.

5.3. ENT Speciality Audit Group The ENT Speciality Audit Group is responsible for the approval and communication of this policy and monitoring compliance with it.

5.4. Role of Individual Staff 5.5. The diagnostic pathway begins when a request is generated; it progresses via the diagnostic testing process and ends when treatment is given or when a report is received by the requester and acted upon. Various Audiology Healthcare scientists, support and administration staff are involved in this pathway. 5.6. Clinical staff are responsible for ensuring that results are communicated where appropriate to the requestor and that appointment requests are generated as required. Clinical staff are also responsible for informing the patient of the result or when not applicable for providing the patient with timescales and contact details to chase results if necessary. 5.7. Administrative staff and clinical staff also have a role to play in ensuring Audiology appointments are booked, medical notes are requested and traced and appropriate preparation instigated in accordance with agreed operating policies. 5.8. Department and Outpatient based Administrative staff have a responsibility that Hospital notes are despatched in a timely manner. 5.9. All staff members are responsible for: 

Being aware of this policy and any documents referred to within it pertaining to their part in the diagnostic pathway.



Adhering to any requirements described within this policy and documents described in the standards and practice section pertaining to their role in the diagnostic pathway.

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6. Standards and Practice 6.1. Content The content of this section takes account of the information provided in the overarching Trust-wide policy which in turn is informed by the document and template provided by the NHSLA (amended to incorporate revisions to the Standards in January 2012) and is used to provide details and information describing the practices, systems, and processes staff are expected to follow in order to comply with this document.

6.2. Diagnostic tests provided by the service A list of tests provided by the Audiology Service is available in Audiology shared folders/secshare/reception folder.

6.3. How diagnostic testing procedures are risk assessed 6.4. All tests are carried out in accordance with recommended BSA/BAA guidelines or equivalent with staff appropriately trained in accordance with the RCHT Medical Devices Training Policy. No new tests will be added to the list of tests provided by Audiology without first undergoing local risk assessment. 6.5. Information relating to incidents and complaints are monitored by the Head of Audiology and reported to Audiology departmental meetings. Any common themes which may indicate an area of increased risk will be identified and acted upon.

6.6. Measures that need to be in place for the diagnostic test to enable any preparation of the patient Where these are required this will be indicated in the patient information that is sent with the appointment letter.

6.7. Identifying the process for ensuring that informed consent is obtained prior to a diagnostic test Consent for investigations is obtained by the professional carrying out the test. Verbal consent is obtained at time of test by the clinician for routine and low risk procedures such as a PTA or is given in line with ‘best interest’ guidance. The Audiology service follows the RCHT Policy for Consent to Examination or Treatment.

6.8. How the diagnostic test is requested 6.9. The Audiology service accepts requests from multiple referrers for hearing tests (PTA or equivalent) which include GP’s, nursing staff, health visitors, Teachers of the Deaf, Social Services, Consultants, Self-referral from existing patients. 6.10.Care pathways exist for adult hearing services, childrens services and for more advanced diagnostic procedures. These are filed in Audiology shared files secshare/protocols/referrals. 6.11.Requests for referral can be received by telephone, electronically (including C&B) or on paper. Diagnostic Testing Procedures in Audiology

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6.12. How the clinician treating the patient is informed of the result, including timescales 6.13.The majority of patients who receive diagnostic testing in the Audiology service are suitable for direct or self referral and are both assessed and treated within Audiology. The referrer where applicable is notified of the outcome by letter which is generated by the professional (Audiologist) treating the patient within 10 working days. 6.14.Patients seen by direct or self referral who are found to have contra indications or who meet onward referral criteria are informed of the results and either cross referred internally or referred back to their GP for onward referral. In these cases the referral is by letter within 10 working days. 6.15. A large number of patients are also seen for diagnostic testing within a one stop ENT lead clinic. In these clinics a copy of the patient’s Audiogram is filed in the patients notes which then go to the clinic nurse to be available for the ENT consultation. In these clinics the ENT Consultant is responsible for informing the patient of the results and arranging follow up. The diagnostic duty is discharged when the notes are passed to the clinic nurse. 6.16. Where a decision is made by ENT that follow up and/or treatment should be within Audiology and this is not possible on the day of the diagnostic test the clinician will email the Audiology referral account in groupwise to make the referral ([email protected]) 6.17. The email is followed up by a copy of the GP letter sent to the Audiology department usually within 10 working days. 6.18.For more advanced diagnostic procedures and for referrals outside of ENT and Audiology i.e. paediatrics, the treating clinician is informed of the results via letter and where possible return of the hospital notes to the consultant’s secretary. Patients are advised to contact the Audiology service if no follow up or contact has been made after 15 working days.

6.19. How the patient is informed of the result, including timescales 6.20.Patients are normally informed of the results of any diagnostic tests at the time of testing by the professional who undertakes the testing procedure. Copies are available for patients to take away with them at request. 6.21.Where a patient cannot be informed of the result i.e. if part of a battery of investigations, they will be informed of the result by the referring clinician either at a further Outpatients appointment or by letter. 6.22.100% of patients will have their diagnostic test within 5 weeks 6 days (unless they choose otherwise). 95% of patients will receive treatment within 18 weeks of referral. 6.23.Where ‘red flag’ results are found the patent will be booked directly onto the outpatient system for an urgent appointment or sent directly to the ENT ward for urgent treatment. Diagnostic Testing Procedures in Audiology

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6.24. Actions to be taken by the clinician, including timescales 6.25.The professional undertaking the diagnostic test will take responsibility for documenting the result in either the patient electronic record (auditbase) or the patient’s hospital notes and for capturing the activity within the hospital PAS system. 6.26.Depending upon the care pathway the professional will either: a) Complete an outcome slip requesting a further appointment within Audiology. At peripheral sites the Audiologist will usually book the required appointment when outcoming the clinic at the end of the day. Where this is not possible the outcomes will be passed to the Audiology administration staff who will outcome the appointment within 3 working days. b) Pass the hospital notes to a clinic nurse so that the patient can be seen immediately in the one stop ENT outpatient clinic. c) Place the notes in the appropriate tray in the Audiology reception for tracing to the appropriate ENT consultant. d) Generate a letter for typing by administration staff who will then forward the notes the appropriate clinician in a timely manner – within 10 working days. e) Where ‘red flags’ exist arrange for the patient to be seen urgently as described in section 6.8.5 above 6.27.The person receiving the results should ensure the results are brought to the attention (urgently if necessary) of the clinical team currently caring for the patient. A letter informing the patient of any action will be generated. 6.28.The Audiologist /professional undertaking the diagnostic testing will take full responsibility for the accuracy of investigations or for querying the validity of results where mismatches with subjective testing occur.

6.29. How the minimum requirements are recorded 6.30.Requests - All requests received are booked an appointment on the PAS system either electronically or manually. Appointments booked manually are given a ‘service code’ to identify the procedure to be undertaken. Diagnostic testing is undertaken within 5 weeks 6 days from receipt of referral except where monitoring protocols or age criteria exist. Waiting times are monitored by weekly RTT reporting 6.31.Informing the clinician:   

A paper recording of the test result is placed in the patient’s medical notes and forwarded to the requesting clinician (ENT). A written report is sent with the hospital notes or with the test result to the treating clinician An internal referral form or outcome slip is generated for use within the Audiology department. A follow up appointment is generated within 10 working days.

6.32.Informing the patient - Records are kept of any written correspondence with the patient or their Doctor in Maxims. Records are kept of discussions (in person Diagnostic Testing Procedures in Audiology

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or over the telephone) in the Audiology patient record, Auditbase. 6.33.Actions taken – where appropriate actions taken are documented within the patients electronic individual management plan or within the GP letter.

7. Dissemination and Implementation (including education & training) This document will be emailed to all Audiology staff and presented at ENT audit. A copy will be placed on the Cornwall & Isles of Scilly Health Community Documents Library and in Audiology shared folders sechare/policies.

8. Monitoring compliance and effectiveness Element to be monitored

1. RTT referral to Treatment times 2. Outcomes within 10 working days 3. Informing the clinician treating the patient of the result; ensuring they are looked at/acknowledged 4. Informing patients of results

Lead Tool

Head of Audiology 1. Trust RTT reporting tools 2. Trust incomplete outcome report 3. Annual audit to track 20 randomly selected tests to check if results have been correctly acted upon, documented and patient informed as necessary. 4 Annual satisfaction survey Monthly/Annually Reports will be reviewed in Audiology departmental meetings and at ENT audit sessions annually or more frequently if problems detected.

Frequency Reporting arrangements

Action plans will be developed in response to issues identified. Acting on The Audiology Head of Service will ensure that action plans are recommendations taken forward within reasonable timescales and escalate to line and Lead(s) manager any outstanding issues. Change in practice and lessons to be shared

Required changes to practice will be identified and actioned within the minimum achievable timescale. The Audiology Head of Service will identify a lead member of the team to take each change forward where appropriate. Lessons learnt will be shared with all the relevant stakeholders.

9. Updating and Review This policy will be reviewed every two years or sooner if circumstances suggest this may be necessary.

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10. Equality and Diversity 10.1.This document complies with the Royal Cornwall Hospitals NHS Trust service Equality and Diversity statement.

10.2. Equality Impact Assessment A completed Initial Equality Impact Assessment Screening Form is at Appendix 2.

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Appendix 1. Governance Information Document Title

Diagnostic Testing Procedures in Audiology

Date Issued/Approved:

23rd June 2015

Date Valid From:

1st May 2015

Date Valid To:

30th April 2018

Directorate / Department responsible (author/owner):

Julie Folkard Head of Audiology, Division of Surgery, Trauma and Orthopedics

Contact details:

01872 254903

Brief summary of contents

This policy sets out an approved documented process whereby the risks associated with diagnostic testing procedures in Audiology are managed.

Suggested Keywords:

Diagnostic, Test, Audiology, Hearing, ENT RCHT 

Target Audience

PCH

CFT

KCCG

Executive Director responsible for Policy:

Medical Director

Date revised:

7th April 2015

This document replaces (exact title of previous version):

Diagnostic Testing Procedures in Audiology V1.0

Approval route (names of committees)/consultation:

ENT Audit group.

Divisional Manager confirming approval processes

Duncan Bliss

Name and Post Title of additional signatories

Melissa McDermott, Lead Paediatric Audiologist

Signature of Executive Director giving approval Publication Location (refer to Policy on Policies – Approvals and Ratification): Document Library Folder/Sub Folder Links to key external standards Related Documents:

{Original Copy Signed} Internet & Intranet

 Intranet Only

Clinical / ENT and Audiology NHSLA Standard 5 – Criterion 7: Diagnostic Testing Procedures  Safer Practice Notice 16, February 2007  An Organisation-wide Policy for the

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Management of Diagnostic Testing Procedures  Policy for Consent to Examination or Treatment  Medical Devices Training Policy Training Need Identified?

No

Version Control Table Date

Version No

23 Mar V1.0 12 7 April 15

V2.0

7 April 15

V2.0

Summary of Changes Initial Issue Replacement of Audiology Team Leaders Group with ENT Specialist Audit Group

Removal of ENT appt request slips with email to Audiology referrals address

Changes Made by (Name and Job Julie Folkard Title) Head of Audiology Julie Folkard

Julie Folkard

All or part of this document can be released under the Freedom of Information Act 2000 This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy on Document Production. It should not be altered in any way without the express permission of the author or their Line Manager.

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Appendix 2.Initial Equality Impact Assessment Screening Form Name of service, strategy, policy or project (hereafter referred to as policy) to be assessed: Diagnostic Testing Procedures in Audiology Is this a new or existing Procedure? Directorate and service area: Existing Audiology, Diagnostics Name of individual completing Telephone: 01872 254903 assessment: Julie Folkard 1. Procedure Aim* Sets out an approved documented process whereby the risks associated with diagnostic testing procedures are managed through the provision of local policies which are implemented and monitored. 2. Procedure Objectives* The risks associated with diagnostic testing procedures are minimised; compliance with NHSLA Standard 4 – Criterion 4: Diagnostic Testing Procedures is achieved. 3. Procedure – intended To ensure that the diagnostic process contributes the Outcomes* maximum benefit to the treatment of patients. 4. How will you measure the outcome?

As described in Section 8.

5. Who is intended to benefit from the Procedure?

All patients

6a. Is consultation required with the workforce, equality groups etc. around this procedure?

No

b. If yes, have these groups been consulted? c. Please list any groups who have been consulted about this procedure.

*Please see Glossary 7. The Impact Please complete the following table using ticks. You should refer to the EA guidance notes for areas of possible impact and also the Glossary if needed. 

Where you think that the policy could have a positive impact on any of the equality group(s) like promoting equality and equal opportunities or improving relations within equality groups, tick the ‘Positive impact’ box.

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 

Where you think that the policy could have a negative impact on any of the equality group(s) i.e. it could disadvantage them, tick the ‘Negative impact’ box. Where you think that the policy has no impact on any of the equality group(s) listed below i.e. it has no effect currently on equality groups, tick the ‘No impact’ box.

Equality Group Age

Positive Impact

Negative Impact

No Impact 

Disability



Religion or belief



Gender



Transgender



Pregnancy/ Maternity Race



Sexual Orientation



Marriage / Civil Partnership



Reasons for decision



You will need to continue to a full Equality Impact Assessment if the following have been highlighted:  A negative impact and  No consultation (this excludes any policies which have been identified as not requiring consultation). 8. If there is no evidence that the policy promotes equality, equal opportunities or improved relations - could it be adapted so that it does? How?

Full statement of commitment to policy of equal opportunities is included in the policy

Please sign and date this form. Keep one copy and send a copy to Matron, Equality, Diversity and Human Rights, c/o Royal Cornwall Hospitals NHS Trust, Human Resources Department, Chyvean House, Penventinnie Lane, Truro, Cornwall, TR1 3LJ A summary of the results will be published on the Trust’s web site. Signed ________________________________________ Date _________________________________________

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