Standard precautions, which include appropriate personal barriers, hand hygiene, disinfecting surfaces, sterilizing instruments, and disposing of infectious waste, apply to the care of all patients regardless of their diagnosis and are crucial in preventing the spread of disease in an audiology clinic.

To effectively prevent the spread of disease, it is important for audiology clinics to have a written infection control plan in place. This plan should include protocols for mode and route of transmission, as well as guidelines for personal protective equipment, hand hygiene, and cleaning and disinfecting of equipment and surfaces.

Implementing and adhering to a written infection control plan is crucial in protecting both patients and healthcare workers from the spread of infectious diseases in an audiology setting.

There are six required sections of the infection control plan. Your written infection control plan does not have to necessarily be in this exact order, but it must include these six required portions. 

1. Employee exposure classification
2. Hepatitis B (HBV) vaccination plan
3. Plan for annual training and records
4. Plan for accidents and accidental exposure follow‑up
5. Implementation protocols
6. Post‑exposure plans and records

infection control is a required element of for any clinical location where audiology services are provided.  You need to create a written infection control plan with work practice controls that are unique to your clinic, and keep in mind, every location within a practice must have their own plan.  Use standard precautions as your guide and integrate appropriate products to ensure that you are meeting the goals of the infection control plan.  Implement the plan, and rely on resources to guide you. 

For further information, refer to Dr. Bankaitis’ blog, www.aubankaitis.com, where you can find a section on infection control.  The book, Infection Control in the Audiology Clinic, is available via Oaktree Products. Please feel free to email her at au@oaktreeproducts.com 

Thursday, January 19, 2023 | 12:00 PM EST

An annual Infection Control Plan for audiology is a document that outlines the measures that an audiology clinic, multi-specialty medical practice and hospital & academic facilities will take to prevent the spread of infections among patients and staff. This plan should be reviewed and updated regularly, at least annually, to ensure that it reflects the current guidelines and best practices for infection control in the field of audiology. This course will focus on how to identify and create work practice controls requirements of the writing infection control plan.

Speaker: A.U. Bankaitis, PhD

Dr. A.U. Bankaitis is the leading expert on infection control in the hearing industry. She earned her PhD from the University of Cincinnati in 1995 where her research publications on HIV and the auditory system led to a niche expertise in infection control. Since joining Oaktree Products as Vice President in 2004, she is a recognized resource to the hearing industry. Her extensive clinical and business experiences allow her to provide straightforward, practical solutions to providers and business owners. If you have had questions about infection control, you probably have reached out to or been referred to Dr. Bankaitis.

Participants will be able to:

1. Explain the role of work practice controls within the audiology ancillary
2. Describe the process of identifying necessary work practice controls to integrate within the writing infection control plan
3. Create a work practice control for audiology

1-hour AMA Category 1 Credit (LIVE session only)
1-hour Audiology CEU (AAA) (LIVE session only)

Back for more! Week two & three of the special series on Cochlear Implants. This week we hear all about Candidacy with Terry Zwolan, PhD, Melissa Hall, AuD, Craig Buchman, MD, Ted McRackan, MD, Paul Shea, MD and Matt Bush, MD.

Check out today’s newest episodes!

Episode 7: Terry Zwolan, PhD | Cochlear Implants Series, Finding the Easy Button | If you were looking at a timeline of impactful events in cochlear implant history, you’d find Dr. Terry Zwolan’s name listed on a lot of them. This episode touches on one of her latest, the 60/60 – which is a simple way to know if the patient in front of you should be considered for CI. She talks candidacy, new codes and everything in between.

Episode 8: Melissa Hall, AuD, SLP | This episode focuses on the kiddos, and the village of providers, specialists, family and friends that are needed to not only help them find success, but that work hard to ensure that these children are thriving.  From identifying this population, to understanding the red flags, to asking more specific questions, Dr. Hall covers a lot of ground.  Listen up and get caught up with what is happening in pediatrics and cochlear implants.

Episode 9: Craig Buchman, MD | Cochlear Implant Series, Candidacy, Outcomes & Oddball Cases | This episode digs into cochlear implant candidacy and loops listeners into some of the most up-to-date changes that were announced by CMS. Dr. Buchman shares his perspective on where the specialty is going, outcomes, why they are focusing on hearing preservation, and even reveals some less thought about indications that maybe should trigger a referral for a CI assessment.

Episode 10: Ted McRackan, MD | Cochlear Implant Series, Real-Life Outcomes & Quality of Life | What picture do you have framed on your desk to help remind you not to make assumptions about patients?  Listen as Dr. Ted McRackan talks real-life outcomes of patients with CI, and dives headfirst into the Cochlear Implant Quality of Life Profile (CIQOL) framework. He relays challenges in connecting test results with a patient’s perceived real-world function, and shares insight into how providers can use this type of data during discussions of expectations with potential CI users and throughout a CI patient’s care. 

Episode 11: Paul Shea, MD | Cochlear Implants Series, When a patient is 90 years young. Should we consider an implant? A surgeon’s perspective | This episode provides insight into the candidacy decision and conversations that happened before KK’s mom had her cochlear implant surgery at age 90 years young.  Dr. Shea also talks neurotology, cochlear implants and private practice; and the collaboration needed to facilitate the best care for prospective cochlear implant candidates.  

Episode 12: Matt Bush, MD | Cochlear Implant Series, Available but not accessible, talking health disparity, access, and fixing problems together.  In this episode, Dr. Matt Bush talks about approaching the hard issues of delivering care in low resource communities and developing trust. Find out what’s being done, and the collaborative approach needed to continue to open the door to access.

Stay up to date with us on LinkedIn, Facebook, Twitter and Instagram @MedAudPro.

Joining the MedAudPro Provider Community is a great way to support our show, get free access to behind the password content and interact with other providers looking to practice at the top of their game. Subscribe today at bit.ly/JoinMedAudPro

This episode is sponsored by Envoy Medical.

Ever wish there was a fast way to get up to speed on a complicated topic? Well, you’re in luck. This series might just be for you. As providers, it’s hard to stay on top of all the specialties in a multi-specialty world. So join us for the month of October and get back in the loop about everything that’s happening in cochlear implants from the fundamentals, candidacy, patient characteristics and the latest in tech – and you’re going to hear it from the best of the best.

This series drops in groups of episodes each week, served up in a sprint, through the month of October ending the week of November 7th. The goal is to help busy providers stay at the top of their game, by delivering the what’s happening, how we got here and where we’re going, in short episodes that are casual and easy to listen to. You can’t help but be just a little smarter by spending 20 minutes with one of these special guests. Who should be listening? Any provider who sits in front of a patient that may have hearing loss. Some episodes are narrow and detailed, focused on the otolaryngology & audiology of it all, but most are bigger picture and meant to bring in all the providers that are part of the patient’s journey to better hearing. If you practice along that continuum, than enjoy the catch-up by these impressive experts – if you know them, well, you know that you should listen up and if you don’t know these folks – then you’re in for real treat.

We open the series with the Fundamentals, basically a little overview and a little history; kicked off by Brent Lucas, CEO of Envoy Medical, followed up by my co-host, Camille Dunn, PhD. Then we meet Donna Sorkin, Jolie Fainberg, AuD, Aniket Saoji PhD and KK Gross. Next up, Candidacy with Terry Zwolan, PhD, Melissa Hall, AuD, Craig Buchman, MD, Ted McRackan, MD, Paul Shea, MD and Matt Bush, MD. Then we dive into Patient Characteristics with special guests Bruce Gantz, MD, William Shapiro, AuD, Jill Firzt, PhD, Rene Gifford, PhD, Sarah Sidlowski, AuD, PhD, and then rounding out the series with Tech and What’s Next featuring Lisa Aubert, MS, Ray Gamble, Victoria Carr-Brendel, PhD and Brent Lucas, JD. And keep your ears open for a few surprises along the way!

Check out today’s newest episodes below and be watching for the next group of episodes, dropping next week!

Episode 1: Cochlear Implants: Special Series | Introduction with Brent Lucas | Join us for the month of October for this special series on all the things that are happening in Cochlear Implants. Hear from the experts as they break down what is happening with CI in 2022. And if you’re wondering why the CEO of Envoy Medical is opening the series? Well, let’s find out!

Episode 2: Meet my Co-host, Camille Dunn, PhD | We wouldn’t be doing a CI podcast without her!  Meet Camille Dunn, PhD, CI expert audiologist, industry leader and genuinely kind and funny person that I’m lucky to call a friend.  I’m so glad she raised her hand and offered to co-host this much needed series on everything that is happening with Cochlear Implants.  I used to think that CI was for a small group of patients and that there was only a small group of providers that delivered the care – not any more.  CI in 2022 is breaking all the rules for the better of everyone – get in the loop quick with the short series podcast covering the fundamentals, candidacy, characteristics and tech – all with the best of the best.  

Episode 3: From patient to advocate, Donna Sorkin shares her extraordinary journey | Meet Donna Sorkin, the Executive Director of ACI Alliance.  She’s had quite a journey.  She gives credit to her audiologist that went above and beyond, in a time when recommending CI may not had been the norm.  That experience inspired her to become a champion of others and was the beginning of a new career of advocacy. Check out the ACI Alliance Provider Resources Here  

Episode 4: Walking the walk with Jolie Fainberg, AuD | Did you ever want to meet someone that has worked with all of the cochlear implant models that have ever been released in the US?  Well, now you have. Dr. Jolie Fainberg has quite the perspective on how the field has changed over the years.  Don’t miss out on the insight.

Episode 5: The Inventor Among Us, with Aniket Saoji, PhD | Do you remember what it felt like when you got the call that your patent was accepted?  me neither.  But this guy… he could tell a story.  Meet Dr. Aniket Saoji. He is an audiologist that understands the clinical and industry perspective, as he’s worked for the manufactures, he holds more patents than I can count on all my fingers and toes, and he sits at the helm of the audiology department at Mayo Clinic, Rochester MN.  

Episode 6: When Your Parent is the Patient. A Caregiver Perspective with KK Gross. In this episode, KK shares her experience with cochlear implants from the caregiver perspective.  Her mom, who had a sudden hearing loss in one ear over 30 years ago, decided she wanted a cochlear implant, at the young age of 90.  This short episode is an overview of that story.  

Stay up to date with us on LinkedIn, Facebook, Twitter and Instagram @MedAudPro.

Joining the MedAudPro Provider Community is a great way to support our show, get free access to behind the password content and interact with other providers looking to practice at the top of their game.  Subscribe today

This CI special series is sponsored by Envoy Medical.

Dr. X’s review went something like this:

1 STAR Rating: “If I could leave a negative star review, I would. Avoid Dr X. My mom was on vacation when she fell.  Unfortunately, she was “cared” for by Dr. X.  Dr. X said, ‘unless my mom wanted to play professional sports, she did not need surgery’. My mom was in a lot of pain and when she returned home, she saw another doctor that said my mom needed surgery right away or she would lose mobility!  The HELPFUL doctor couldn’t believe that Dr. X didn’t even change the bandages…. Dr. X, bring light and good health to the world by retiring.”

Like anyone who receives a review like this, the doctor was upset and completely disagreed with the reviewer’s account of the visit. He immediately instructed the staff to post a response with the “facts”, and then began to pressure his team to have Google delete the reviewer’s comment. As you can imagine, even if the reviewer isn’t responding, the outcome is not positive for the practice or the doctor; and if the reviewer is responding, the outcome likely only gets worse.

So, we know that bad reviews happen, even to the very best of providers.  How should we handle them, and how can we manage the conversations within the clinic and with the providers?

Step One: Consider your options.

The first rule of Review Club: work the plan. It’s easy to allow any review, especially a not-so-great-one, to feel very personal.  The key to success is the consistent, long game. Just like managing any situation that isn’t going perfectly within the business, the goal should be to consider your options and work the plan. This is the very reason there is a Customer Review Strategy in place to begin with; it is the clinic’s time to shine.  An emotional response, particularly a direct response including any details around the patient visit, may not only validate the patient’s identity and easily be a HIPAA/privacy violation, but it often fuels the fire. Consider the options and work the plan; but what is the plan?

Step Two: Remove.

Does the review qualify as inappropriate in Google’s eyes? Getting rid of a Google review is not necessarily simple, but it isn’t impossible either.  Google only removes reviews if the reviewer breaks one of Google’s user policies. 

Google Review Policies:

1. Spam and fake content that is posted to manipulate ratings. This includes posting multiple times, including from different accounts.
2. Off-topic posts that are general in nature, such as political commentary or personal rants.
3. Promoting actions be taken or items purchased that fail to comply with local legal regulations. Such restricted content includes promoting alcohol, gambling, guns, pharmaceuticals, adult services, and more. 
4. Illegal or depict illegal activity, such as copyrighted content, endangered animal products, graphic violence, human trafficking, etc.
5. Terrorist in nature.
6. Sexually explicit or in any way sexually exploits children.
7. Offensive, obscene, or profane.
8. Dangerous, considered harassment or intimidating, or that incite hatred.
9. Impersonating others or having false representation.
10. Dishonest or biased. This includes posting reviews of your own business (or having a current or former employee do it for you) and trying to manipulate a competitor’s ratings.

So, does this review qualify for deletion under any of these policies? In this instance, our review does not qualify for removal.  If you believe, after reviewing the policies, your business can prove the reviewer broke one of Google’s policies, you have a chance to present your case. I’ve included an abbreviated overview of how to contact Google support below.

To contact Google’s support for small businesses:

1. Go to Small Business Support
2. Scroll down and select “contact us”
3. Select “customer reviews and photos,” and then “manage customer reviews”
4. Choose to receive help via phone, web chat, or email

Using any of these methods, one can expect help within 24 hours. If the practice chooses to contact Google via email or chat, it is helpful to have a screenshot of the review in question ready to go.

When the Google support team reaches out, it is up to the practice to explain why the review should be removed. Be ready to explain why the review is in violation of policy and defend your request to get it removed.

CLICK THIS LINK to request to delete a review from Google.

Step Three: Respond

If having Google remove the review isn’t going to work for the practice, the easiest way to have a review removed is having the patient remove it themself.  Typically, this is accomplished by contacting the patient offline with hopes to better understand what happened and find a way to resolve the issue.  Where this approach can become risky is when a well-meaning practice representative accidentally validates a patient’s claim during the casual phone conversation, for instance, by apologizing for the incident or mishap.  Apologizing opens the door, if only a crack, to admission in a malpractice action and trying to have the patient see it “your way” may inflame the patient instead of inspiring them to remove a post. 

Additionally, engaging with the reviewer may prompt more online discussion.  There is nothing stopping a patient from replicating their comments on multiple online platforms.  Businesses that have the most success responding to poor reviews utilize only their most experienced, skilled and disciplined staff, and those team members stay within a very defined framework.  Additionally, having some sort of fix readymade that directly addresses the patient concern is imperative.  The caller must have a plan to resolve the issue going into the conversation.

Step Four: Move On.

Sometimes time is the best healer. When a practice has an active reputation program in place, one bad review won’t be disruptive in the bigger picture; and confronting the reviewer is most often, not worth the risk.  If the practice has an active program to solicit reviews, in a few weeks this review will be buried by an overwhelming number of other reviews that for the most part, should be very good.  If this is a one-off, the manager or clinical supervisor can make note and move on.  If there seems to be a trend within the practice, this time is a great opportunity to meet with the provider or team to realign, fix a process or define a new approach. 

Overall, having an active reputation program in place, understanding your Customer Review Strategy and working your plan to consider, remove, respond or move on will improve the online reputation of your practice and the providers that work within it.

No matter your role within a company, CEO, administrator, clinical director to an entry-level position, soft skills are essential in helping you thrive in the workplace. They are so important that when something isn’t working or feels off, it is often rooted in a soft skillset vs. a technical skill mishap.  They are used and beneficial in any company, in any industry. If you find yourself with new work responsibility or the chance for one, soft skills are often one of the drivers for your newfound success, the reason you were hired, or why someone is trying to recruit you into a position.  #KnowYourStrengths #UnderstandYourWeaknesses #DoTheWork 

Here are some of the top soft skills that recruiters, hiring managers and business owners are looking for to drive success in a remote work environment:

• Accountability: Take responsibility for outcomes. This could be for an action you’ve done yourself, participated in as a team and most importantly, for your direct reports. The buck stops here – and you are the here.
• Assertiveness: Be confident in yourself and allow yourself the grace to not always be right. Don’t let fear of being wrong stop you from sharing and participating.  Acting courageous and enthusiastic with your communications and actions isn’t always easy, and it is often necessary. And don’t forget to balance your newfound assertiveness with respect, it will take you and your good work farther.  If you need to fake it till you become it, practice. 
• Collaboration & Teamwork: Do not be afraid to ask for help or to help others. Some tasks are better done together and partnering can get work done faster. Combine your efforts and resources toward a common goal and be respectful of others if they have a different viewpoint or method of getting a job done. In some instances, you may need to compromise. In others, do not be afraid to swallow your pride if the task gets completed in the desired outcome. It’s amazing what you can accomplish if you don’t care who gets credit.
• Conflict Management: Maintaining a healthy relationship with your coworkers is crucial to have a productive work environment. Conflict management is a skillset that helps you compromise and resolve disagreements in a respectful manner. Don’t let little things build up into big issues, and work to solve misunderstandings on a one-to-one basis first, in-person, video chat or over the phone – not in email or text.  
• Practical: Have calm, commonsense thinking. Think realistically when it comes to goals and outcomes and the time it will take to reach them. Setting unrealistic goals in unrealistic timeframes to often leads to failure and disappointment. This doesn’t mean you shouldn’t dream and push, if simply means that big visions need a level of practically to come true. 
• Creativity: Think, do, and express in ways that are outside of the box. This could be by creating new design ideas, processes or simply variations of current techniques to get tasks done. 
• Critical Thinking: Think in a disciplined manner that is clear, rational, open minded, and evidence based. Looking at problems from different points of view often opens new paths to solutions.  Take the side you disagree with most and argue for it – exercises like that will open your mind and allow you to determine options more openly.
• Enriching Others: Give positive reinforcement and support to those around you. Help create a healthy positive work environment. Be accepting of other’s differences. Mostly, find ways to contribute to the greater good of a project and others.
• Problem Solving: Hone the ability to identify obstacles. Discuss, analyze, and solve for challenges in both conventional and unconventional ways. 
• Productivity: Set and meet goals. Work hard but smart. Prioritize, plan, and manage tasks to knock them out of the way and to achieve your best results.
• Relationship Management: Build relationships with those around you. Be aware of their emotions and take them into consideration if they’re having a bad or unsuccessful day. Stop the often-natural tendency to think the worst and give everyone the benefit of the doubt.  You’ll appreciate it when they do the same for you.
• Self-Assessment: Self-reflect. Determine your strengths and limitations. See where you would add value to a situation or where you could improve and reach out for help. Often understanding your biggest weakness
• Service Orientation: Anticipate and meet people’s often unspoken needs. This can be done by helping them, introducing them to products, or services. Strive to achieve customer satisfaction and loyalty. Show them how you stand out from other places by being attentive and insightful. 
• Stress Tolerance: Be able to endure pressure and uncertainty without becoming negative toward self or others. Be able to handle fast-pace or changing environments or excessive workloads through proper management methods. Don’t be afraid to reach out for help when needed. 

As you read that list, did any skills resonate as talents you feel you may already possess?  How about those that stick out as opportunities for improvement? First, you should identify the soft skills you naturally align with or that you feel you already have mastered. These should appear under Strengths on your resume, during interviews, and as you look for ways to add value to your current team. 

Are you uncertain about what these might be? It’s sometimes hard to understand your strengths, particularly if it is something that comes more naturally.  A good way to identify the skills that should already be listed in your Strengths Column is to ask your current or former boss, talk with coworkers and close friends or take online assessments. Next, to strengthen the skills you feel are important but may lack mastery, read about them, inquire about training that may be available through your current job, or even take an online class. There are many online or in-person classes that vary in length and depth. It is also useful to interview someone who has the skill or skills you’re hoping to start working on. There is a lot to learn from those that are already practicing what you hope to develop.

As we think back to the first days of the pandemic lock down, it brings back vivid memories of uncertainty; fear for ourselves and our patients and wondering how we could continue to serve our patients who were already predisposed for isolation by the pure nature of hearing loss.  Never in our lifetime had we been asked, or in some cases told, to shelter-in-place due to a medical threat. The healthcare world was managing difficult questions of how we keep people safe while still being able to serve their medical needs.  The discussions were swirling in the media, in phone conversations with colleagues and within practices on what is considered “essential healthcare services” when a community is faced with a global pandemic?  Some classified “essential” as anything required to save a patient’s life; others considered anything that negatively impacts a patient’s quality of life as “essential care”.  As a medical provider that witnesses the impact on the overall health and wellness that even an untreated mild hearing loss can bring, knows that for most, untreated hearing loss has substantial consequences when the world is managing normal circumstances. Now to be isolated at home, without support systems like family and friends, created an environment where a patient’s only contact with the world is through a video or phone call, television, radio, and social media.  We argued that hearing care services were even more essential in everyday life, now more than ever, hearing was a person’s primary lifeline.

At that point, we started asking ourselves, how can our physicians and providers meet patients where they are: in the community, at their homes, and on their connected devices. Although some of these changes will reverse as the world feels safer and more comfortable, we believe that there has been a fundamental shift in the delivery care.  We already had digitally enabled care in some ways, through apps and our patient portal, we needed to expand our care delivery and inform our patients.  We ultimately learned to connect to our patients in new ways, through: telemedicine appointments, remote-programming schedules, drop-off services and curbside care; and we are not looking back. 

To make patients feel as safe as possible and meet the social distancing guidelines, medical professions were able to start providing telehealth visits to meet their healthcare needs in a time that being in an exam room with a patient was not “safe”.  In audiology, we can provide a vast number of services via telehealth, however, we must have our patients positioned to move to this type of care.  What do I mean by this?  Remote programming has been available in hearing instruments for quite some time, but not widely adopted due to licensing concerns as it relates to telemedicine and audiology.  But once again, COVID 19 created a window where prior telehealth regulations by insurers were loosened so patients could be provided healthcare as it was needed, and providers could receive payment.

In hearing care, we had the answer – remote programming.  Thankfully, the hearing instrument manufacturers had been incorporating remote programming capabilities for quite some time. That said, many of us did not wholly appreciate the effort until COVID hit unexpectedly. And even then, many of us were not fully prepared to deliver it to the bulk of our patients. Our practice had written hearing aid delivery guidelines that include activating any remote programming capabilities in the hearing instrument. So, in theory, as part of our clinical protocol, all instruments are to be set up for remote care services.  Guess what happened when the pandemic started?  We quickly discovered that for whatever reason, many providers had not initiated the remote capability.   As I investigated the reasons why it had not been done, the first reason was time, they didn’t have enough of it during the delivery of the technology to add another feature and counsel on it.  However, the biggest reason was they didn’t think the patient would use it.  And for the most part, at that time, they weren’t wrong.  Most of our patients set in-person appointments for their follow-up and on-going hearing care.  When we look back now, we just weren’t planning for a pandemic-like environment.  We had been delivering care one way, for a very long time; and only for extreme cases, like illness or distance, did we ever really use any type of phone consult, telemedicine visit or remote programming capability as a practice.  Wow.  We were wrong about adaptation when there are extenuating circumstances and other available care channels to receive help. 

This is where the Curbside Care Channel journey began for ENT and Allergy Associates of Florida.  To service our patient’s hearing instrument needs, we first had to have all hearing aids prepared for remote programming, which for most patients meant we needed their instruments in the clinic. However, at this time during the pandemic, we couldn’t have the patients physically in the hearing aid clinic, and thus, Curbside Care was born.  While servicing the patient this way, we could wear proper personal protective equipment, do the proper patient attestation, take temperatures, and mostly stay at the required social distance. Best of all, we could take the patients hearing instruments from them and prepare them for remote programming while they sat in the safety of their own car.

The next hurdle was figuring out how to inform our patients about the new way to visit the office. We wanted them to know that we were here for them.  The fastest way to engage with them was on our social media of course.  We went “Live on Facebook” on ENTAAF’s Hearing Clinic social channel and talked about the new way to visit the office, how the Curbside Care would allow us to assist them safely, what remote programming meant and communicated that they did not have to be our patient to get help. 

As providers, we focused on how we could manage the situation within the government guidelines and still find solutions that would meet the needs of our patients while protecting the staff.  Even though what we came up with may even seem outside-of-the-box, we simply focused on how to meet the needs of the patient by managing them “where they were”; and in this case, they were in their car. After all, some practices still utilize the care channel of ‘at-home’ care, and take care of patients where they live, we surely could be creative enough to manage care if they would drive to us.

Considerations when adding or maintaining this modern delivery channel:

1. Put a clinical guideline in place that requires that if remote programming features are available, they are activated at time of fitting.  Next, add this feature to your chart review process to monitor provider compliance.
2. Assess the parking spaces around the practice to determine best parking spots to assign as Curbside Services.
3. Assure you have adequate signage designated for the curbside area and that you have communicated to the patient how to notify the office when they arrive.
4. Familiarize and train support staff on services that can be provided curbside and how to triage patients between face-to-face care, drop-off service, remote programming appointment and curbside care.
5. Become familiar with all manufacturers remote capabilities allowing your team to manage patients that may have purchased from other locations. Understanding what is available also allows the practice to determine if there are other products that may meet the needs of current patients.  
6. Develop manufacturer specific checklists listing the required steps the provider must execute to enable remote programming capabilities in products.
7. Regroup with your providers and staff to discuss benchmarks around different care channels, talk about how they are doing, and what they are seeing with patient outcomes.  Remember, there is always a way to improve the experience for both your patients and the team that is providing the care.

Hopefully, we are turning the corner on this pandemic.  With that, many patients are still not comfortable being in the office, and for many, having to come into the office is a burden. We believe that Curbside Care and Remote Programming Appointments are here to stay in the world of hearing care.  Moving forward, we will continue to deliver hearing care in these newer channels.

Do you currently have a mid-level provider?

Yes, we have two mid-level providers, they are both physician assistants.

How many years have you had a mid-level provider working within your practice?

We began to use mid-level providers in our practice about 10 years ago.

What circumstances made you consider adding a mid-level provider versus adding an additional physician provider?

In considering how to bring additional value to the practice, we needed more providers to help manage patients in our office.  We had a growing practice, and the in-office visits were increasing at a rate that was pushing out new patient visits beyond what we felt was acceptable.  We also wanted the providers that were managing patients here to have the same care philosophy as the other ENT partners. We felt like it was a real opportunity to expand our availably, reduce our wait times and patient frustration with getting access quickly and most importantly, we wanted to be able to train the mid-level providers ourselves.  Physician assistants aren’t usually specialized, so the opportunity to train them to our care model, align them with our guidelines & best practices and ultimately, position our provider team to be an extension of us as physicians.

In what capacity do you use your current mid-level providers?

Our physician assistants were hired with the intention for them to develop their own patient base and manage their own caseload. We wanted our patients to have greater access to our practice and to us as ENT providers.

Is there a selection criterion that you use when considering a mid-level provider in your practice?

There are many considerations when selecting any provider for your practice.  For us, we wanted someone that was eager and motivated to learn, open to additional training, and had a great work ethic. Being able to train “on the job” for a mid-level within the practice allows for molding the care delivery model to one that is consistent from one physician to the other when they are practicing with more than one physician.  It allows for standards to be established that are consistent to the office and patient need, not just to the interest of the physician partners. 

Are there any limitations to the types of patients that you direct toward your physician assistants?

How a mid-level provider is used within a practice can vary greatly based on the specialties of the training physicians as well as other medical providers on the care-team, for instance, audiology and speech pathology. In our case, our PA’s have built their own patient load with reoccurring patients while assisting with practice growth by taking on new ENT patients, just as a physician partner would be expected to manage their schedule.  We utilize our mid-level providers for most office-based procedures; however, we do put limits on some patient types, for example: airway obstructions and nose bleeds; but the limitations of each mid-level provider may vary based on their area of interests as well as experience, eye-hand coordination, and depth perception, as these are requirements when working in the ear, especially as microscope use is typically required.  

What type of on-boarding process and training do you use when introducing mid-level providers to the specialty of ear, nose and throat?

How training is approached is determined initially by the experience of the mid-level provider. We were fortunate the first PA we added at our location had been working in the ENT specialty for some time prior to joining our practice.  We were able to take the experience that she had from her prior employment and build on it.  We focused more our assuring she was comfortable with the fundaments and then moved toward the care philosophy we have established for our practice. Our second PA came aboard without any experience in ENT.  However, she had great familiarity with us as a practice, as she had worked on the administrative side of our practice as she was working on her PA degree.  This gave us great comfort in hiring, as we already knew her, loved her work ethic and knew she would be open to our training and practice care philosophies.  She was already a great fit with our team and our patients.   

Is there a difference in microscope training skills for a mid-level provider versus an ENT resident?

As medical residents, most of your learning begins in the cadaver lab as well as working with patients in surgery.  This is very different than the physician assistant that learns these skills on alive, alert patients. It takes practice to work under a microscope, but with a planned approach, “see one, do one, teach one” allows for direct and ongoing oversight until the mid-level provider has mastered the microscope.

How do you feel the mid-level provider brings value to your practice?

Adding mid-level providers to our practice allowed us to provide more comprehensive care and follow-up with our patients. Our patients often recommend our PAs as a primary provider to friends and family. This speaks to the quality of care our mid-level providers give to our patients.

When considering the different patient types and procedures that a PA can manage in your office, what do you consider in the training process as it relates to liability?

Just as physicians, mid-level providers may have skills that align with different types of procedures and treatments within the office.  There are some limits we set for treating patients initially, airway obstructions and nose bleeds to mention a couple examples.  Deciding how a PA will be used in a physician practice is determined by the skills of the provider, as well as the comfort of the physician that is supervising. They do ultimately work as a team.

Clinical trials have been used in the world of medicine for years, but now we are seeing an increase in trials that are more ENT-Audiology based.  An analysis of trial registration data downloaded from Clinical Trials.gov and utilizing administrative data from the Duke University Medical Center from October 1, 2007 to September 27, 2010 revealed a total of 1115 registered interventional trials assigned to otolaryngology.  Of these, head and neck cancer trials predominated.  But what is happening in this space in 2021 is nothing short of an explosion. At the time of this article, there are 797 current clinical trials in the hearing loss space as listed on Clinicaltrials.gov.  Although head and neck cancer trials are still leading in number, there is a significant uptick in trials for new pharmacological treatments & medications for sensorineural hearing loss, age-related hearing loss, tinnitus, and dizziness just to mention a few. There are also a number of ongoing FDA studies related to different devices used in treating hearing loss.

Our practice is currently involved in 14 clinical trials ranging from procedure trials to medication trials.  We have a clinical trial team that finds trials that may interest our physicians and providers, presents them as opportunities for the practice and then applies to the study. There are several steps from the time of application to when a site is accepted for participation in the trial. Each step of the process builds on the other until subject recruitment can begin. Look for our upcoming article on the Business of Clinical Trials.

As an audiologist, I believe some of the most exciting trials today are the studies investigating restoring the cochlear synapse.  It is more recently believed that when the cochlear synapse is impaired, it directly impacts a person’s ability to understand in noise.  This is supported in research on hidden hearing loss. This article discusses hidden hearing loss at length; the authors suggest this type of selective neural loss may be the physiological basis for many of the cases of hearing disability with a normal audiogram.

If you have been performing audiological testing on patients for any period of time, you most likely have come across a patient with a similar story. A patient presents with a concern about their hearing, you perform a hearing test, and everything appears to be within normal limits.  If we weren’t performing speech in noise testing at the time, did we tell them they had normal hearing? did we miss them altogether? I think about early in my career where we assured patients, as did our physicians, that their hearing was “within normal limits”, but was it really hidden hearing loss that went undiagnosed because the current research hadn’t suggested it existed yet, we weren’t performing an expanded standard battery on all patients, or we simply weren’t asking the right questions?

As we know, speech-in-noise testing is often not standardly performed, unless it is tied to a larger work-up like a cochlear implant assessment, an auditory processing disorder battery or part of hearing aid verification. Today, providers have the opportunity to dig a little deeper when the patient’s primary complaint is specifically related to difficulty understanding in noise, and their hearing is within normal limits.   In this situation, hidden hearing loss could still be missed without pushing beyond the basic audiometric testing. Now that the clinical trials and research are focused more than ever on hearing loss and other audiologically related symptoms, we need to become even more vigilant by consistently managing patients with robust patient history and expanded standard diagnostic practices.

Within our clinical guidelines at ENTAAF, the Quick Sin is included as part of our standard audiological battery, and still there are times where it isn’t done.  It is true that it takes slightly more time, and sometimes that makes it difficult to keep schedules on time. We find that performing the QuickSin or the Words in Noise (WIN) test adds about 3 minutes to the testing battery.

As audiologists, one of the most important things that we can do is to take the lead in educating the other medical providers that are involved in managing our patients with hearing loss.  When we provide them with peer reviewed articles that support the benefits of adding this into our regular battery, it better aligns our recommendations.  The audiogram has been thought by many to be the picture of what is happening with our patients hearing, but the truth is, we are finding that the basic audiologic battery used in most practices may not be robust enough to tell the whole story.

Listed below are a few things discovered in this journey to gain a better picture of our patient’s hearing health. By adding speech in noise testing to our clinical battery we have seen a number of benefits. 

The additional test:

1. Assists patients in understanding the complexity of hearing speech in a noisy background.
2. Allows us to quantify the degree of difficulty that patients are experiencing when listening in noisy environments and compared against normative data
3. Presents a testing environment that mimics where our patients complain they have the most difficulty, in noise.
4. Provides insight into those that end up having thresholds within normal limits but still feel they have significant difficult with speech in noise environments.
5. Gives us a baseline of performance to assess the benefit and project outcomes for the recommended aural rehabilitation programs.
6. Provides a robust group of patients to access information on speech in noise performance, allowing us to participate in clinical trials surrounding cochlear synaptopathy as well as opens up other clinical trials that involve hearing loss & audiological testing.  

If your practice location has been involved in clinical trials, then you know that there are several considerations before adding this service into your practice. Look for our upcoming series on the Business of Clinical Trials.