Background: Audiologists often work collaboratively with other health professionals—particularly
otolaryngology providers. Some form of written reporting of audiologic outcomes is
typically the vehicle by which communication among providers occurs. Quality patient
care is dependent on both accurate interpretation of outcomes and effectiveness of
communication between providers. Audiologic reporting protocols tend to vary among
clinics and providers, with most methods being based on preference rather than standardized
definitions.
Purpose: As part of an ongoing quality-improvement program, audiologic communication was reviewed
by comparing written audiometric reports to descriptions of the audiometric results
dictated by otolaryngology providers to evaluate the agreement of communication between
provider groups.
Research Design: Retrospective chart review.
Study Sample: The study sample consisted of 6000 randomly selected charts from a total of 15,625
for the years 2004 and 2008 in the electronic medical record system of a large academic
health-care system.
Data Collection and Analysis: Audiogram reports and associated otolaryngology reports were reviewed by an audiologist
and two audiology doctoral students. Communication occurred among 37 audiology providers
and 39 otolaryngology providers. Data collected included rating of congruence or incongruence
between reports, normal versus abnormal audiologic outcomes, and the nature of communication
disparities. Data also included provider type (audiologist, audiology doctoral student,
or trainee in clinical fellowship year [CFY]; otolaryngologist, otolaryngology resident,
physician assistant, or nurse practitioner).
Results: Incongruent results were higher among the sample of audiologic evaluations with abnormal
outcomes (29.2%) compared with normal outcomes (9.5%). Of those cases rated as incongruent,
differences in reporting audiometric results stemmed largely from variance in reporting
of numerical values from the audiogram (20%), apparent dictation errors (10.1%), and
communication of the ear tested (8.6%). Of those cases in which the interpretations
of audiology providers differed from those of otolaryngology providers, incongruent
results occurred in the interpretation of degree (29.4%), tympanometric results (28.2%),
type of hearing loss (12.8%), acoustic reflex results (4.0%), symmetry (3.3%), and
other domains (4.2%). Rates of incongruent results were similar regardless of experience
level of the audiology provider (audiologist or audiology doctoral student/CFY) but
differed depending on the educational background and experience of the otolaryngology
provider. The highest incongruent interpretations were found among residents (32.5%),
followed by otolaryngologists (25.2%) and physician assistants and nurse practitioners
(21%).
Conclusions: This study highlights the need for audiologists to critically evaluate the effectiveness
of their communication with other health-care providers and demonstrates the need
for evidence-based approaches for interpreting audiologic information and reporting
audiologic information to others.
Key Words
Audiogram - audiology - communication - observer variation - otolaryngology
