March 13-15, 2016 • San Diego, CA


  |   -   |  9 - Program Evaluation and Quality Improvement

From Incomplete Screening to Diagnosis: An Unexpected Clue Aids Timely Identification

In addition to pass/refer results upon completion of automated ABR screening, error messages are also incorporated into the functionality of the screening equipment used at St. Jude Medical Center in Fullerton, California. In particular, an automatically generated Reverse Leads message alerts the screener to a possible incorrect application of the vertex (non-inverting) and nape of neck (inverting) lead and prevents continuing the screening procedure. This provides the opportunity to correct the misplaced leads. However, if the leads are in their correct positions with the Reverse Leads message displayed, screening personnel face decisions regarding further screening attempts, scheduling an outpatient rescreen, or proceeding directly to diagnostic follow-up. In May 2015, a Reverse Leads message occurred at St. Jude Medical Center while screening a baby in the NICU (Neonatal Intensive Care Unit). The hearing screener had applied the leads correctly and the test could not be completed. A decision was made to suspend further screening attempts. The baby was referred to a pediatric audiologist for diagnostic ABR testing and confirmed to have Auditory Neuropathy Spectrum Disorder (ANSD). Reports of this error message in infants subsequently diagnosed with ANSD have been reported in several locations previously, including two well nursery infants described in a presentation at the 2010 National EHDI conference( “10 Years of UNHS: Quality Improvement is Perpetual for Parkland Universal Hearing Screening Program” Shoup A, Owen K and Jackson G). These examples highlight the importance of understanding screening equipment and the implications of error messages during screening, continuous attention to the reasons for incomplete screenings, and the value of ongoing review of hospital screening protocols. In light of lessons learned from experience, it is important to provide continuing education in order to avoid loss to follow-up or delays in diagnosis and intervention.

  • Participants wil be able to explain the importance of knowing the functionality of their hearing screening equipment. Specifically, error messages, and how this knowledge can aid in early identification and diagnosis.

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Denise Metalsky (Primary Presenter,Author,POC), Peloton Screening Services, denise.metalsky@natus.com;
Denise Metalsky is an Audiology professional with over 20 years of experience in the Hearing Healthcare Industry. Her background includes Medical Devices Sales and Marketing, Universal Newborn Hearing Screening and direct patient care in the form of Clinical Audiology. She has been the Southern California Area Supervisor with Peloton Screening Services for over a year, serving babies and their families. She lives with her husband and two children in Redondo Beach.


Financial - Receives Salary for Employment from Natus Medical Inc..  

Nonfinancial - No relevant nonfinancial relationship exist.

Judith Marlowe (Author), Natus Medical Incorporated, jmarlowe@natus.com;
Since 1971, initiated audiology programs (hospitals, non-profits, ENT office) and in solely owned private practice. Established 1983 universal newborn screening program; Founding Director, Auditory-Verbal International, 1987-2006, AVI President,1991-1993; Founding Director, AG Bell Academy for Listening and Spoken Language, 2006 - Publications: twenty-four works in American Journal of Audiology, Seminars in Hearing, Volta Review, Australian Journal of Education of the Deaf, American Annals of the Deaf and contributed book chapters; presentations throughout U.S, Canada, Mexico, Europe, Australia, New Zealand, India, Saudi Arabia,UAE, Japan, Singapore,China. Honors: Outstanding Young Women of America (5 issues); Who’s Who of Women Executives; Who’s Who in U.S. A. Health Specialists; Who’s Who in America; and Who’s Who Worldwide;Strathmore’s Who’s Who; International Sertoma “Service to Mankind” Award; Marion Downs Award; 2002 Saint Thomas More Medallion/ Commencement Speaker; 2003 Thomas More Professional Achievement Award; University of Cincinnati Communication Disorders Twenty-five Most Prominent Alumni,1989; University of Cincinnati Communication Disorders “2005 Distinguished Alumnus.”


Financial - Receives Salary,Ownership interest for Employment from Natus Medical Incorporated.   Receives Salary,Ownership interest for Employment from Natus Medical Incorporated.  

Nonfinancial - No relevant nonfinancial relationship exist.