As
head of the technical department at Bispebjerg Hospital, Erik Kjaerboel was invited to join the screening
pilot project in the initial phase with a focus on technological requirements. However, he soon came
to play a lynchpin role in the design and implementation of the project, especially in the development
of an effective training program. Erik also created software for centrally collating data collected
from all screening sites.
A screening protocol designed for efficiency
For the purpose of speed and efficiency, it was decided early on that primary screening was to be done by OAE and re-screening by OAE and AABR. This decision simplified the choice of equipment: “there was already an AccuScreen in our department...and we needed equipment that could perform both kinds of tests (OAE and AABR).”
Thorough personnel training is essential
Another important prerequisite was the need for well-trained and highly motivated staff who would be able to handle the screening process, the equipment, the babies and the parents with confidence. Erik helped plan and conduct a 5-day course, which ran three times and trained a total of 57 biomedical analysts, midwives and nurses.
The program taught everything from the role of being a screener to learning all the technical audiological aspects of the screening. It also covered the importance of healthy hearing for learning good communication, and included practical training with the AccuScreen. When questioned about the length of the course Erik replied “5 days is good for motivation and I think you need this. Especially for learning parent counseling. They were just very, very positively motivated from the outset.”
Taking care of the parents
The training course also included some crisis psychology and role-playing to prepare participants for the difficult task of dealing with parents when screenings don’t give an unambiguous pass: “We taught them to say that it’s a fault in the measurement, it’s not that the child doesn’t hear, although there is a risk that the child doesn’t hear, but that could be because the ear is full of fluid, vernix, etc. It’s a balance. We don’t want to create any unnecessary anxiety on the part of the parents.”
Low referral rates and high coverage
As the channel for receiving all test data, Erik manages the statistics for the program. While the target for the first year of the program was 80% coverage, more than 93% of all infants have been screened. As at 20.09.05, that represented a total of 4560 neonates, 70 of which had been referred for re-screening at Bispebjerg (1.5%); 3 infants were later diagnosed with bilateral hearing impairment and 1 with unilateral impairment.
Tympanometry at 1000 Hz
When asked about possible improvements to the procedure, Erik Kjaerboel mentioned expanding the follow-up with middle-ear testing using a 1000 Hz probe tone: “we do have the equipment now and we’re going to include it in the protocol. If we have an AABR response at 45 dB and not at 35 dB, and a flat tymp, we know it might be caused by fluids – it’s very important to have that information at an early stage.”