Using COVID-19 as an Opportunity to Improve Patient Care

While the coronavirus (COVID-19) crisis presented huge challenges to the healthcare system, it also provided opportunities for innovation in the field of patient care. GBMC’s mission is to every patient, every time, provide the care we would want for our loved ones, and the Presbyterian Board of Governors Cochlear Implant Center of Excellence at GBMC truly took that to heart over the past six months.

For those with hearing loss, the pandemic has been especially difficult. The widespread adoption of face coverings muffles the voice and visually blocks the mouth, making it challenging to hear and impossible to lip read. With impacted communication, many cochlear patients and those with hearing loss have struggled with feelings of isolation. It became apparent that ensuring optimal performance was critical. Unfortunately, during the time that in-person care was provided for emergent cases only, the Cochlear Implant Center found it challenging to provide service to patients in need of care.

The staff at the Center recognized patients’ needs and the fact there would be a backlog of patients when restrictions were lifted. They decided to reevaluate their current protocols to ensure patients were receiving the most comprehensive and efficient care possible. Using GBMC’s Model for Improvement – Plan, Do, Study, Act – the Center began to examine patient data, both within the GBMC HealthCare System and from other Cochlear Implant Centers around the world.

Plan: Develop a Hypothesis

When analyzing patient attrition rates (the rate of patients lost to follow up), the staff discovered that many patients, both at GBMC and globally, stop seeking care approximately one year after implant surgery. The Center typically offers annual follow-ups, and they hypothesized that these follow-ups may not actually be necessary to ensuring positive patient outcomes.

Do: Conduct an Experiment

The Center’s staff reached out to previous patients and other hearing health experts to evaluate the effectiveness of post-activation follow-ups and determine which ones were clinically important. They participated in virtual national conventions and outreach programs to better understand strong clinical protocols and efficient practices. They found that many patients stop seeking care because they were performing well and did not feel that office visits were necessary on an annual basis.

Study: Evaluate the Results

After confirming that some follow-ups were not audiologically necessary, the Center looked into ways that the time for those follow-ups could be redirected to care for new patients. “Our goal is to serve more people without jeopardizing current patient care,” said Regina Presley, Au.D., FAAA, CCC/A, Senior Cochlear Implant Audiologist. “We want to develop high quality care in a way that creates a seamless transition for our patients.”

Act: Refine, Standardize, and Stabilize Protocols

The Center is now implementing a revised protocol and sharing the results with others in the medical community through publications and international presentations. They are educating both patients and colleagues about the services offered at the Center to ensure that patients have access to hearing healthcare. Hearing is vital to communication, education, occupation, and overall health. Hearing loss has been linked to dementia, diabetes, and cardiovascular issues, just to name a few. It affects many aspects of a patient’s wellness and by sharing data with primary care providers and other specialists, the Center is ensuring that patients receive care not only for their hearing health, but for their health overall.

During these unprecedented times, the Center continued to strive towards better care during the pandemic. In April, the Center participated in a controlled market release of Remote Check, a brand-new technology that allows clinicians to virtually assess and troubleshoot cochlear implants. GBMC was one of just 10 centers across the country chosen to be part of the initial release. Staff also worked to enhance care for patients who could not be treated remotely through curbside service and office modification. They utilized an existing observation room and video captioning technology to communicate. With a physical barrier in place to protect both the patient and clinician, providers were able to remove their masks to allow patients to see the visual cues they rely upon for communication.

In addition, clinicians in the Center dedicated time to creating educational and rehabilitative materials to help patients and their caregivers navigate through the cochlear implant journey from start to finish. These new materials help patients create realistic expectations and track their progress as they adapt to their cochlear implant. The Center is sharing these resources with other hearing professionals across the country and is serving as an example for cochlear centers nationwide.

GBMC is incredibly proud of every member of the Cochlear Implant Center team. Thank you for your dedication to continuous improvement and for the amazing care that you provide to patients every day!