The cochlear implant champion scheme was launched by Martin O’Driscoll from the BCIG and Ann-Marie Dickinson from the BAA Service Quality Committee at the BAA conference 2019. The aim of the scheme is to ensure all eligible adults and children, and their families, are well-informed about cochlear implants and are offered a timely referral.
ROLE OF THE CHAMPION:
To train, support and empower staff in your team to counsel patients/clients and their families about cochlear implants (CIs).
To ensure all eligible patients/clients and their families are offered informed-choice and shared-decision making when considering a CI referral.
To audit, the quality and quantity, of CI referral counselling taking place in your service, and monitor referrals.
The first CI Champions training workshop took place on the 11th March 2020 at the BCIG conference in Nottingham, with online training and support offered pre- and post-workshop. The champion role is important for audiologists working in a paediatric and adult setting, in the NHS and independent sector. Subsequent training sessions have taken place in September 2020 and May 2021. Presentations from these training sessions are in the members’ area here.
You should be motivated and committed to the scheme. You should have good communication skills and be prepared to share information and guide/inform discussions about implants within your team.
RESPONSIBILITIES OF THE CHAMPION:
The BAA are currently looking for new members to join the CI Champions Committee. We recognise the diversity in our profession’s workforce and would like to encourage applicants from all backgrounds to better reflect this diversity. We are keen to hear from independent sector clinicians, as well as clinicians with a rehabilitation role/focus.
The Mentor is a role taken on by an experienced CI audiologist who works within a CI team. Their role is to support the Champions, who will each support their own team. The Champions and Mentor form a link between implant and referral services.
Cochlear implants should always be considered as a priority for adults with severe-to-profound deafness; however, it is important to ensure adults are optimally aided so they can get the best possible outcomes with their hearing aids.
The optimally added definition exists to support clinicians when making a decision about how to set hearing aids for adults who have severe to profound loss, and when to refer for a cochlear implant. Download the document here: Optimally Aided
Allen, S. Jones, L., Gregory, M. (2018) Addressing the low uptake of cochlear implants amongst adults. The Ear Foundation.
Bierbaum, M, McMahon, C, Hughes, S, Boisvert, I, Lau, A, Braithwaite, J & Rapport, F 2019, Barriers and facilitators to cochlear implant uptake in Australia and the United Kingdom. Ear and Hearing.
Chundu, S., Buhagiar, R. (2013) Audiologists’ knowledge of cochlear implants and their related referrals to the cochlear implant centre: Pilot study findings from UK, Cochlear Implants International, 14:4, 213-224, DOI: 10.1179/1754762812Y.0000000025.
Dillon, B., Pryce, H. (2019): What makes someone choose cochlear implantation? An exploration of factors that inform patient decision making, International Journal of Audiology, DOI: 10.1080/14992027.2019.1660917.
Fitzpatrick, Elizabeth M.; Ham, Julia; Whittingham, JoAnne. Pediatric Cochlear Implantation, Ear and Hearing: November/December 2015 – Volume 36 – Issue 6 – p 688-694 doi: 10.1097/AUD.0000000000000184
Gaylor, J., Raman, G., Chung, M., Lee, G., Rao, M., Lau, J., Poe, D. (2013) Cochlear Implantation in Adults A Systematic Review and Meta-analysis. JAMA. Otolaryngol Head Neck Surg. 2013;139(3):265-272.doi:10.1001/jamaoto.2013.1744
Ng, Y., Lamb, B., Harrigan, S., Archbold, S., Athalye, A., Allen, S. (2016) Perspectives of adults with cochlear implants on current CI services and daily life, Cochlear Implants International, 17:sup1, 89-93, DOI: 10.1080/14670100.2016.1157314.
Mr Raghunandhan Sampath Kumar, Ms Deborah Mawman, Mr Divyan Sankaran, Mrs Christine Melling, Dr Martin O’Driscoll, Mr Simon M. Freeman & Professor Simon K. W. Lloyd (2016) Cochlear implantation in early deafened, late implanted adults: Do they benefit?, Cochlear Implants International, 17:sup1, 22-25, DOI: 10.1080/14670100.2016.1161142
Sandeep G. Mistry, Simon Carr, Jane Martin, David R. Strachan, Christopher H. Raine & Georgios Fyrmpas (2017) Cochlear implantation under local anaesthesia – Our experience and a validated patient satisfaction questionnaire, Cochlear Implants International, 18:3, 180-185, DOI: 10.1080/14670100.2017.1296986
Raine, C. (2013) Cochlear implants in the United Kingdom: Awareness and utilization, Cochlear Implants International, 14:sup1, S32-S37, DOI: 10.1179/1467010013Z.00000000077.
Raine, C., Atkinson, H., Strachan, D., Martin, J. (2016) Access to cochlear implants: Time to reflect, Cochlear Implants International, 17:sup1, 42-46, DOI: 10.1080/14670100.2016.1155808.
(2020) Hearing outcomes of cochlear implant recipients with pre-operatively identified cochlear dead regions, Cochlear Implants International, 21:3, 160-166,
Turton et al (2020) Guidelines for Best Practice in the Audiological Management of Adults with Severe and Profound Hearing Loss. https://pubmed.ncbi.nlm.nih.gov/33364673/
For around 50% of adults referred, a CI is not found to be the best treatment option . Given this figure, expectations should be managed from the start of the pathway to avoid feelings of disappointment. This document has been developed and agreed by BCIG and BAA Service Quality Committee to support appropriate counselling and ensure clinicians can provide suitable information whilst still ensuring patients understand that following the assessment process, they may not be suitable and/or benefit for a CI.
This factsheet is written for adults with a severe to profound hearing loss who are thinking of having a cochlear implant assessment. Please note, this document is compatible with text to speech readers (for people who are partially sighted or blind). An easy-read version will be available soon.
• How is our service performing against the gold standard?
• Useful period to audit: March 2019-2020 (after NICE change, pre-champions, pre-Covid)
• Weekly/monthly audit/re-audit: How does our service currently perform against the gold standard?
• Is the training/support changing practice? What else needs to be done?
• Who are we missing?
• Which staff need more support?
• What needs to change/be developed?
Adaptions to this schedule
• Baseline does not need to be an entire 12 months.
• Ongoing does not need to audit every day/week/month.
• Develop a schedule to suit your time and resources available; anything better than nothing!
How to use the audit results:
What could your training look like?
A team approach
Thank you to the following people for contributing to the Audit Toolkit:
Lisa Kennedy and Anirvan Banerjee, North East Regional Cochlear Implant Programme; Joseph Blackaby, Southend University Hospital NHS Foundation Trust; Katie McNeill, North Devon Healthcare Trust; Lousie Fletcher, Walsall Healthcare NHS Trust; Rashmi Singh, Cochlear and Tom Lyon, Royal Free London NHS Foundation Trust
NICE 2018 ‘After the audiological assessment, discuss with the person, referral for implantable devices such as cochlear implants, bone-anchored hearing aids, middle-ear implants or auditory brain stem implants, if these might be suitable’ NICE, 2018, pg. 20, https://www.nice.org.uk/guidance/ng98
Babies and children 0-5:
NDCS (2016) ‘Deaf babies and children who meet the criteria to be candidates to receive a cochlear implant or other implant are referred to an auditory implant service at an early stage for assessment, following discussion with the family’. Page 7. https://www.ndcs.org.uk/documents-and-resources/quality-standards-early-years-support-for-children-with-a-hearing-loss-0-to-5-england/.
Unclear for children over 5. If you want to help determine this gold standard, please email email@example.com
Search for all those eligible according to PTA as determined by NICE, 2019 https://www.nice.org.uk/guidance/TA566
The British Cochlear Implant Group (BCIG) has a Crystal report that was developed after excellent collaboration between Auditdata, a number of pilot Audiology departments (Middlesbrough, Southend, North Devon District Hospital and St George’s hospital) and Cochlear. Given the importance of this project we are pleased to announce that it is now supported by all four cochlear implant manufacturers (Advanced Bionics, Cochlear, MED-EL and Oticon Medical).
The BCIG Referral Report allows Audiology departments to identify and analyse patients who fall within CI audiometric candidacy guidelines in a time-efficient way. Audiologists can monitor what happens to the referral status of their patients over time and identify initiatives to help improve their referral practice. The BCIG can help you find one-to-one support in using the report, analysing the results, and setting action plans.
Please contact firstname.lastname@example.org
Practice Navigator: A report, shared by Champion Louise Fletcher from Walsall, can be used to extract ALL audiograms measured in a certain time frame e.g. 1 week, 1 month, 1 year. Download instructions.
We are unable to load the ‘audiogram analysis‘ file on this website, for a copy of the report please email: email@example.com
A list of patients and their audiograms can then be saved into excel and manipulated to find the patients that meet the NICE criteria.
Search by clinics: e.g. look through your S&P/complex clinics to find those that meet the criteria according to PTA – see talk from BAA 2019 and BCIG 2020 by Ann-Marie (both available on this webpage)
Allocate each patient to a category…suggested categories are:
a) Referred for a CI assessment.
b) Not referred: pt declined a CI assessment
c) Not referred: further assessment needed in audiology
e) No action taken – these patients fail to meet the gold standard
Categories a-d meet the audit gold standard. Category e fails to meet the gold standard
Suggested options are shown below – decide what best meets your patient’s needs depending on urgency, your service set-up, risks of covid etc.
a) Offer a face to face review (with AB word test if possible).
b) Group information sessions
c) Send out information on CIs – Considering a referral for a cochlear implant-leaflet
d) Add notes to prompt staff at their next visit
e) Discuss with your mentor at CI centre -they might be able to help.
The Audit Process
North Devon referral rates March 2019-March 2020
Of 108 patients:
The Audit Process
Southend referral rates
We approached all UK manufacturers of hearing measurement equipment to request video guidance on performing an aided AB word test, specifically for CI referral. We would like to thank Natus (Aurical) and Signia (Unity 3) who both made the videos. Each video includes: