Consultant physicians working with patients - Royal College of ...

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2 Specialties Audiovestibular medicineTable 1 Specialised facilities required by an audiological medicine service for a population of 500,000Hearing testingPaediatric• 3 large paediatric soundproof test booths with viewing areas• 1 standard booth with viewing area• 1 child-friendly, hearing aid fitting room• 1 room for taking impressions• 1 room for nurse-led activities, including a microscope and irrigation for aural toileting• 1 acoustically treated, child-friendly, hearing aid prescription room• 1 room for evoked-response audiometry• 1 counselling room for parents• Sufficient rooms for members of the MDT to see and work with children in a child-friendly environment, including consultationrooms for medical examination• 1 waiting room including supervised play facilities for all ages and available refreshmentsAdult• 4 standard audiometric soundproof test booths• 1 evoked-response booth• 2 acoustically treated, hearing aid prescription rooms• 3 hearing aid fitting rooms• 2 comfortable rooms for hearing therapy• 1 room for nurse-led activities, including a microscope and irrigation for aural toileting• 1 large room for group relaxation classes• Sufficient rooms for members of the team to consult and assess patients• 1 waiting roomVestibular testingPaediatric• 1 child-friendly, purpose-designed, vestibular test room with play area and mains water supply• Facilities for comprehensive vestibular testing, including videonystagmography (VNG), electronystagmography (ENG), rotatingchair, posturography and caloric testing (needs mains water supply)• 1 clinical room for physiotherapy and occupational therapyAdult• 1 large vestibular laboratory from which light can be excluded, including VNG, ENG, rotating chair, posturography and calorictesting (needs mains water supply); it needs to be suitable for children and adults• 1 large room for group relaxation and balance retraining• 1 counselling and cognitive therapy roomOverall service• 1 seminar room for MDTs and for continuing professional development (CPD)• Office space for patient administrationemployment for adults and appropriate domesticsupport for children and adults.5 Delivering a high-quality serviceWhat is a high-quality service?AVPs are medically trained professionals with thehighest level of skills and competencies in the field anddeliver effective and efficient assessment, diagnosis andmanagement of disorders through an MDT in as fewvisits as possible. 12The British Association of Audiological Physicians(BAAP) policy document 2002 13 containsrecommendations for the staff and details of theequipment (less than 5 years old) required for apopulation of 500,000 patients (Tables 1 and 2). Itcovers paediatric and adult vestibular and hearingservices in both community and hospital sites. It alsorefers to the staff required for a team based at a mainunit working across several sites. BAAP published aclinical standards document in 2011 which sets out thegeneric and core standards for working with childrenC○ Royal College of Physicians 2013 39
Consultant physicians working with patientsTable 2 Non-medical staffing requirement for the service provided by an audiovestibular centreProfessional Child Adult Total (500,000) Total (250,000)Audiologist Band 8B 1 1 2 2Band 7 2 1 3 2Band 6 3 3 6 3Band 5 1 3 4 2ATO 2 2 4 2SALT for hearing impaired 2 1 3 1–2Educational audiologist/ATHI 2 0 2 1Deaf role model/sign language teacher 1 0 1 0.5Social worker/counsellor 1 1 2 1Hearing therapist 0 2 2 1Physiotherapist 1 1 2 1Psychologist 1 1 2 1Paediatric occupational therapist 1 0.5 0.25 ?Nurse/healthcare assistant 1 3 4 2Medical secretary 2 2 4 2Receptionist 2 2 4 2A&Crecordsstaff 2 2 4 2ATQ = assistant technical officer; SALT = speech and language therapist; ATHI = advisory teacher for the hearing impaired; A&C = adultand children.and adults with hearing and balance disorders. 14Interdisciplinary standards for specific activities haveTable 3 Audiovestibular medicine guidelinesand auditsBAAP clinical standards and guidelines are available at:www.baap.org.uk/index.php?option=com content&view=article&id=48&Itemid=54NHS Newborn hearing screening protocols andpathways: http://hearing.screening.nhs.uk/publicationsRoyal College of Physicians working party reportHearing and balance disorders: achieving excellence indiagnosis and management 1Department of Health documents Improving access toaudiology services in England; Transforming adulthearing services for patients with hearing difficulty;National service framework (NSF) for older people; NSFfor children, young people and maternity services; andNSF for long-term conditions. All these documents areavailable at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/index.htmbeen implemented, eg NHSP 15 and ModernisingChildren’s Hearing Aid Services (MCHAS). 16Maintaining and improving the quality of careMaintenance and improvement of service quality isensured by clinical governance, which includes: development of patient-care pathways, systems andprocesses to improve the efficiency of patient flow appraisal and peer-review system revalidation participation in accreditation of audiologydepartments, eg Improving Quality In PhysiologicalDiagnostic Services (IQIPS) adherence to published clinical standards(see Table 3) and the development of national andlocal guidelines reviewed by audit participation of AVPs in BAAP specialty-specificnational audit participation of AVPs in regional and national work,eg for BAAP and in partnership with otherprofessional and voluntary bodies such as the British40 C○ Royal College of Physicians 2013
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