Same-Day Patient Consultation and Cochlear Implantation: Patient Experiences and Barriers to Implementation

Patient Preferences in Cochlear Implant Manufacturer Selection

OBJECTIVE

To assess the factors that drive a patient's selection of cochlear implant (CI) manufacturer.

STUDY DESIGN

Prospective survey study.

SETTING

Tertiary referral center.

PATIENTS

One hundred twenty-eight adult patients undergoing primary CI.

INTERVENTIONS

Survey administered in the preoperative area.

MAIN OUTCOME MEASURES

Sources of information regarding CI manufacturer offerings, factors that were most important in deciding on a manufacturer, and manufacturer ultimately selected.

RESULTS

One hundred twenty-eight patients were included (average age, 63.7 years; 97% White). The most cited source of information that patients used to choose a device was his/her audiologist (80.5% of patients). When asked his/her number 1 reason for choosing their CI manufacturer, the most commonly cited reason was technology (e.g., battery life, device pairing), regardless of manufacturer. When asked about specific technology offerings, hearing aid pairing was rated as the most important. The numbers 2 and 3 reasons for choosing a manufacturer were cosmetics/structure of the wearable portion of the device and audiologist recommendation of that manufacturer, respectively. The relative weight given to each of the top 3 reasons differed significantly across the three manufacturers ( p = 0.017).

CONCLUSIONS

Audiologists are by far the leading source of information used by patients choosing a CI manufacturer. Patients prioritize technology most when choosing an implant manufacturer, but audiologist recommendation and the cosmetics and structure of the wearable device are also important. CI manufacturers should be mindful of patient priorities when designing and marketing their devices.

How to Teach an "Old Dog" New Tricks: Improving Clinical Efficiency in a Well-Established Cochlear Implant Program

OBJECTIVE

To evaluate the implementation of a new streamlined service delivery model for cochlear implant (CI) patients at a mature academic CI program.

SETTING

Tertiary referral center.

PATIENTS

CI candidates and CI users.

INTERVENTIONS

Implementation of a new CI service delivery model.

MAIN OUTCOME MEASURES

CI surgical numbers, conversion rate from CI evaluation to surgery, documentation time, number of visits for new versus established CI users, ratio of CI clinical full-time equivalency to CI surgical numbers, time from CI referral to CI evaluation, patient travel burden.

RESULTS

De-identified data from the electronic health record (EHR) were used to develop an efficiency improvement plan. With the old clinical model, audiologists' schedules were at capacity, wait for CI evaluation appointments was prolonged, and CI surgical numbers were declining. The new model implemented an interactive electronic medical record, a de-escalated postoperative programming schedule, inclusion of telehealth pre-CI surgery, and an evidence-based approach to CI programming. After a 4-year time period (2019-2022) of implementing clinical improvement strategies, the postoperative CI programming schedule in the first year after activation was reduced from 10 visits (unilateral CI user) and 16 visits (bilateral CI user) to 4 visits total. This saved the patient up to 16 hours of time at the clinic, reduced travel burden, and opened 19 weeks of appointment slots for new patients. Increased utilization of the EHR and telehealth increased the conversion rate from CI evaluation to CI surgery by 33% and decreased the no-show rate by 5%. Annual CI surgical numbers subsequently increased by 45% with the new model, which increased our program's CI utilization rate and reduced our role as a barrier to CI care.

CONCLUSION

If CI programs wish to be instrumental in improving CI utilization rates, clinical care models need to be adapted now in preparation for the projected rise in the number of potential CI candidates. This streamlined clinical efficiency model serves as an example of patient-centered CI care that can be recreated at other institutions. Outcomes from our 4-year strategic initiative will add to the scarcity of literature in this area.

Barriers to Cochlear Implant Uptake in Adults: A Scoping Review

INTRODUCTION

Cochlear implants (CIs) provide access to sound and help mitigate the negative effects of hearing loss. As a field, we are successfully implanting more adults with greater amounts of residual hearing than ever before. Despite this, utilization remains low, which is thought to arise from barriers that are both intrinsic and extrinsic. A considerable body of literature has been published in the last 5 years on barriers to adult CI uptake, and understanding these barriers is critical to improving access and utilization. This scoping review aims to summarize the existing literature and provide a guide to understanding barriers to adult CI uptake.

METHODS

Inclusion criteria were limited to peer-reviewed articles involving adults, written in English, and accessible with a university library subscription. A cutoff of 20 years was used to limit the search. Barriers uncovered in this review were categorized into an ecological framework.

RESULTS

The initial search revealed 2,315 items after duplicates were removed. One hundred thirty-one articles were reviewed under full-text, and 68 articles met the inclusion criteria.

DISCUSSION

Race, ethnicity, and reimbursement are policy and structural barriers. Public awareness and education are societal barriers. Referral and geographical challenges are forms of organizational barriers. Living context and professional support are interpersonal barriers. At the individual level, sound quality, uncertainty of outcome, surgery, loss of residual hearing, and irreversibility are all barriers to CI uptake. By organizing barriers into an ecological framework, targeted interventions can be used to overcome such barriers.

Next day cochlear implant switch-on: the New Zealand experience

The objective of this study was to review the practice of next-day cochlear implant activation, or switch-on, after surgery for adult cochlear recipients in northern New Zealand. A retrospective observational study compared next-day and three-week post-surgical outcomes related to early complications, electrode impedance values, speech perception outcomes and the number of patient appointments and speech processor MAPs to the point of stabilisation. Over a five-year period, 167 consecutively implanted recipients were included in this review. Results indicate that less time from surgery to switch-on had no impact on the incidence of wound or fitting complications, and resulted in lower initial impedance measures, fewer hours of follow-up visits and fewer MAPs during the subsequent nine months. Speech perception outcomes did not differ between the early and later switch-on groups. General satisfaction with next-day switch-on practices has resulted in consistent use of this protocol with high patient and clinician satisfaction and improved clinical efficiencies.

Patient and clinician experiences with the multidisciplinary single-day cochlear implant selection (MSCS) protocol

PURPOSE

This study assessed the MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol with a primary focus on sustaining or enhancing patient satisfaction throughout the cochlear implant selection process.

MATERIALS AND METHODS

Following the implementation of the new selection protocol, where all selection appointments take place on the same day, we surveyed 37 individuals who underwent the process. Twenty adhered to the standard procedure, while 17 followed the MSCS protocol. We also gathered feedback from seven out of eight involved healthcare providers. This method enabled us to evaluate the protocol's effectiveness in maintaining patient satisfaction and ensuring staff contentment with care delivery within a condensed timeframe.

RESULTS

Patient responses showed slight variations in average scores without statistical significant differences, indicating comparable satisfaction between the MSCS pathway and the standard protocol. The majority of patients preferred the MSCS protocol, with none of the MSCS participants opting for appointments spread over multiple days. Healthcare practitioners of the CI center also displayed similar or increased satisfaction levels with the MSCS protocol.

CONCLUSION

The adoption of the MSCS in daily clinical care has led to a decrease in patient appointment times without sacrificing patient satisfaction. Additionally, the majority of individuals actively choose the MSCS protocol. Among those who have directly experienced it, there is unanimous preference for the consolidated appointments over spreading them across multiple days. Professionals within the CI team express equal satisfaction with both the new and old protocols, indicating that the reduction in patient time does not diminish overall satisfaction.

Improved Postoperative Speech Recognition and Processor Use With Early Cochlear Implant Activation

OBJECTIVE

To report speech recognition outcomes and processor use based on timing of cochlear implant (CI) activation.

STUDY DESIGN

Retrospective cohort.

SETTING

Tertiary referral center.

PATIENTS

A total of 604 adult CI recipients from October 2011 to March 2022, stratified by timing of CI activation (group 1: ≤10 d, n = 47; group 2: >10 d, n = 557).

MAIN OUTCOME MEASURES

Average daily processor use; Consonant-Nucleus-Consonant (CNC) and Arizona Biomedical (AzBio) in quiet at 1-, 3-, 6-, and 12-month visits; time to peak performance.

RESULTS

The groups did not differ in sex ( p = 0.887), age at CI ( p = 0.109), preoperative CNC ( p = 0.070), or preoperative AzBio in quiet ( p = 0.113). Group 1 had higher median daily processor use than group 2 at the 1-month visit (12.3 versus 10.7 h/d, p = 0.017), with no significant differences at 3, 6, and 12 months. The early activation group had superior median CNC performance at 3 months (56% versus 46%, p = 0.007) and 12 months (60% versus 52%, p = 0.044). Similarly, the early activation group had superior median AzBio in quiet performance at 3 months (72% versus 59%, p = 0.008) and 12 months (75% versus 68%, p = 0.049). Both groups were equivalent in time to peak performance for CNC and AzBio. Earlier CI activation was significantly correlated with higher average daily processor use at all follow-up intervals.

CONCLUSION

CI activation within 10 days of surgery is associated with increased early device usage and superior speech recognition at both early and late follow-up visits. Timing of activation and device usage are modifiable factors that can help optimize postoperative outcomes in the CI population.

Pilot study of a multidisciplinary single-day cochlear implant selection protocol

PURPOSE

This study aimed to explore and introduce the potential of a MSCS (Multidisciplinary Single-day Cochlear Implant Selection) protocol. The primary objectives of this pilot were to reduce the duration between referral and surgery, minimize hospital visits and decrease the time healthcare professionals dedicate to the cochlear implant (CI) selection process.

MATERIALS AND METHODS

We established a pilot program at the CI center of the Erasmus MC, a tertiary referral center in the Netherlands, with the goal of improving and shorten the selection process. We evaluated our pilot, including 15 CI candidates, and conducted a retrospective analysis for time and cost savings.

RESULTS

The results showed that the pilot of the MSCS protocol significantly reduced the length of the CI selection phase (84 days vs 1; standard intake vs MSCS protocol) and the number of hospital visits (6 vs 2 visits; standard vs MSCS protocol), resulting in less travel time and lower costs for the CI candidates. The total time of professionals spend on patients was also reduced with 27 %.

CONCLUSION

This study highlights the potential benefits of the MSCS protocol in terms of reducing the burden on patients and healthcare providers and improving the efficiency of the CI selection process.