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IIR 17-068 – HSR&D Study

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IIR 17-068
Hearing Impairment, Strategies, and Outcomes in Emergency Departments
Joshua Chodosh MD MSHS
Manhattan Campus of the VA NY Harbor Healthcare System, New York, NY
New York, NY
Funding Period: July 2018 - December 2019

BACKGROUND/RATIONALE:
Hearing loss disrupts communication, which in turn jeopardizes effective medical care. Hearing loss is associated with poor mental and physical health, and is remarkably prevalent among older Veterans (close to 80% with bilateral >40 decibel hearing loss, among those 80 and older). Every year, several hundred thousand hearing loss-impacted older persons visit VA Emergency Departments (EDs) - noisy settings that are among the most "difficult listening situations" in clinical medicine. Many older adults will arrive without a hearing assistance device, given the low rate of hearing aid use in the elderly population. Extensive research underscores the importance of good communication during "care transitions" - points in time when patients leave one care setting for another. In the case of the ED, discharge to home may be a risky transition for patients who do not understand discharge instructions, such as which medications to take, or how to recognize "red flag" symptoms that indicate the urgent need for further medical attention. Patients who lack understanding of discharge instructions are at risk for repeat ED visits and/or hospitalizations.

OBJECTIVE(S):
The goal of this study is to test whether providing hearing assistance devices to older age hearing impaired patients in the ED setting will improve in-ED understanding and preparation for discharge.

METHODS:
The proposed intervention, the Hearing Impairment, Strategies and Outcomes in VA Emergency Departments (HearVA-ED) will be conducted in the Emergency Departments of the Manhattan and Brooklyn VAs of the New York Harbor Healthcare System and will recruit hearing impaired ED patients who are 60 years and older and have been admitted to the ED with a low acuity triage score indicating a high likelihood of discharge home. We will identify hearing impairment by using the Hearing Handicap Inventory for the Elderly survey (HHIE-S). Research assistants will approach these Veterans in the ED and request a few minutes to ask a brief survey on hearing. We will randomize consenting patients (goal: at least 68 Veterans) who fail the screening (indicative of difficulty with hearing) to either receipt of a simple hearing assistance device (a "PockeTalkerTM") during their ED stay or to usual care. All will receive audiology information and referrals. We will test whether the provision of a PockeTalkerTM is feasible in this environment (by measuring the amount of device use), whether providing the device improves self-reported quality of hearing and understanding during the ED stay, and whether use of the device improves the quality of preparation for post-discharge care.

FINDINGS/RESULTS:
The study has not yet begun recruitment, so we have no findings yet.

IMPACT:
If this randomized controlled trial demonstrates beneficial effects for in-ED use of a simple hearing assistance device for hearing impaired patients, this strategy can be disseminated throughout the VA healthcare system.

PUBLICATIONS:
None at this time.


DRA: Other Conditions
DRE: TRL - Applied/Translational
Keywords: Clinical Diagnosis and Screening, Symptom Management
MeSH Terms: none