AQP Audiology referral guide for practice staff

In January 2015 a new referral form and referral criteria was implemented for AQP Audiology referrals. Key changes included:

  • Redirecting patients referred with NHS hearing aid problems only back to their supplier and not proceeding with a new referral. (Any referrals for hearing aids will be returned to the practice via the e-Referral Service)
  • Providing patients with contact telephone numbers to enable them to self-refer
  • Returning referrals to GP practices which are incomplete/ not enough information provided or where red flags are present. Referrers will be able to re-submit with additional information at this time
  • At the end of the pathway patients are offered a further review with their AQP provider

Scope

An AQP referral is suitable for patients presenting with age related hearing loss requiring a hearing assessment or reassessment where their hearing needs have changed.

  • This referral pathway is for patients 55 years and over requiring a hearing assessment or reassessment for suspected or diagnosed age related hearing loss
  • Patients requesting a hearing assessment need to have their ears checked by their GP, who may decide to refer them
  • Patients choosing an AQP provider will remain under their care for a minimum of 3 years when they will be offered a further review with that provider

Out of scope

  • Patients being referred for problems with their NHS hearing aids only
  • Paediatrics referrals
  • ENT referrals
  • Complex cases
  • Learning and cognitive difficulties
  • Patients under 55 years of age - and/ or has red flag symptoms should be referred to an appropriate specialist service

Assessment

Signs & Symptoms

Patient presenting with age related hearing loss requires a hearing assessment or reassessment where their hearing needs have changed

History and Examination

GP should assess the patient's ears and suitability for referral

Red Flags

  • Tinnitus as main concern - unilateral/asymmetrical, pulsatile, bothersome/distressing lasting more than 5 minutes
  • Troublesome tinnitus affecting sleep associated with anxiety or depression
  • Abnormal auditory perceptions (dysacusis)
  • Vertigo
  • Normal peripheral hearing but with abnormal difficulty hearing in noisy backgrounds, possibly having problems with sound localisation or difficulty following complex auditory directions
  • Persistent pain affecting either ear (defined as earache lasting more than 7 days in the past 90 days before appointment)
  • History of discharge other than wax within the last 90 days
  • Complete or partial obstruction of external auditory canal preventing proper examination of the ear drum or preventing taking of an impression
  • Abnormal appearance of outer ear and /or ear drum (e.g. inflammation of external auditory canal/perforation/active discharge)
  • Sudden hearing loss or deterioration of hearing (sudden = within 1 week) in which case send to A&E or urgent ENT clinic
  • Rapid loss or deterioration of hearing (rapid = 90 days or less)
  • Fluctuating hearing loss other than associated with colds

Any patients with red flags are not suitable for an AQP referral and should be referred to the appropriate speciality

Investigations

Patients should have their hearing and ears assessed prior to referral.

Is the patient already under an AQP provider for aftercare?
  • Once the patient attends for initial assessment, if hearing aids are prescribed, the patient is expected to remain with the chosen Provider for the length of their pathway (a minimum of three years after last hearing aid fitting).
  • At the end of the pathway patients are offered a further review. The review is only intended for patients who are experiencing problems managing their hearing aid and/or where the patient considers that there has been a significant change in hearing. It is at this point, patients are told that they can change Provider if they wish.
  • If a patient chooses a different Provider , they would be referred back to their GP who will check the patient's ears and refer them on for a further assessment where the process begins again.
  • If the patient chooses to remain with the original Provider , they can then be offered a review appointment and prescribed new hearing aids, if required.
Is the patient in need of hearing aid maintenance
  • Patients will be returned to their provider for hearing aid care and do not need a new referral.
  • Lost aids should not prompt a new referral, providers can charge for replacement aids, in exceptional circumstances the provider can contact the CCG for funding approval, and these would not involve DRSS.

Referral

Referral Criteria

Any patients 55 years of age and over presenting with suspected or diagnosed age related hearing loss, requiring a hearing assessment or reassessment can be referred to an AQP provider.

  • Complete the AQP referral form
  • Include the reason for referral
  • Details of hearing and ear assessment undertaken in primary care
  • Include any relevant medical history including if a home visit is required
  • Check the AQP referral criteria
    • If the patient was offered a hearing aid they would be happy to wear one
    • Both ears are clear of all wax
    • Intact and healthy ear drums
    • No fluctuating hearing loss, ear pain longer than 7 days or discharge within 90 days
    • No unilateral hearing loss and/or unilateral or troublesome tinnitus
    • No sudden onset or rapid deterioration of hearing loss
    • Patient not suffering with dizziness (vertigo)

Referrals submitted without this information will be returned.

If any exclusions and/or red flags are present continue to refer to the appropriate specialist service in either:

  • ENT or
  • Audiology

Referral Instructions

Refer to AQP using the e-Referral Service

  • Specialty: Diagnositic Physiological Measurement
  • Clinic type: Audiology
  • Service: DRSS-South Devon & Torbay-Audiology (ENT)- Devon CCG - 15N

Referral Forms

AQP Audiology - no merge fields

AQP Audiology Microtest

AQP Direct Access Hearing Aid S1

Supporting Information

Hearing Aid Care

Patients who are experiencing problems with their NHS hearing aid do not need a new referral. Patients can contact their NHS hearing aid provider for their aftercare.

Helpful contact details

Chime Audiology Services – 01392 402 223

Specsavers – patient can call the branch they use directly (various locations in Devon)

Outside Clinic – 0800 854 477

Derriford Hospital – 0845 155 8155

South Devon Healthcare NHS Trust – 01803 656 325

North Devon Healthcare Trust – 01271 322 476

Alistair Kinsey - 01822 617883

Express Diagnostics – 01752 720 799

Evidence

This is an administrative guideline created by DRSS to support referral process as outlined by South Devon and Torbay CCG.

Publication date: October 2017

 

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