A recent story in Oncology Nursing Times (Schulmeister 2018) illustrates one of the hazards of hearing impairment. A cancer patient arrived at busy outpatient registration area. The registration clerk copied his name from his driver’s license to a computer search screen and chose the first name from result list and printed a wristband for the patient. The clerk asked the patient if the information was correct and he nodded “yes” (he was not wearing his glasses). He was then sent to a busy infusion center for his second chemotherapy treatment. There, the nurse asked him if his name is John Doe and if his birthday is the date that she read from his wristband. He nodded yes. He didn’t notice she gave wrong birthday because she had a “heavy accent” and “rattled off numbers” and the infusion room was loud and busy and that he “didn’t hear well.” He received the chemotherapy intended for another patient who had the same name but a different birthdate. There was no apparent harm but a lawsuit ensued anyway.
Obviously, there was a cascade of errors and incorrect practices that contributed to this incident. But we include it here because it does point out yet another problem that the hearing impaired are vulnerable to: patient misidentification. This, by the way, is one of scenarios in which biometrics might have helped considerably in avoiding misidentification.
In our July 2018 What's New in the Patient Safety World column “” we noted a study (Lin 2018) that found work- and leisure-related injuries were more prevalent among those with self-perceived hearing difficulty and another study (Simpson 2018) that showed more than 20% higher total healthcare payments among hearing impaired individuals.
Since then, another study has revealed yet another likely vulnerability. Chang et al. (Chang 2018) looked at a representative national sample of patients discharged from hospitals and found that those who reported trouble communicating with their physicians had had 32% greater odds of hospital readmission within 30 days. Their results show we need to raise awareness about the high prevalence of hearing loss among older people and educate staff on how to talk to people with hearing difficulty.
In our July 2018 What's New in the Patient Safety World column “” we noted a study (Mahmoudi 2018) which showed the use of hearing aids was associated with reduced probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital.
In an editorial accompanying the Mahmoudi study, Wallhagen (Wallhagen 2018) points out that hearing assessment can be simple and not time consuming. You can use a combination of a simple question and a brief objective test like a finger rub or whisper test, or a brief questionnaire like the Hearing Handicap Inventory for the Elderly. She points out that this takes minimal time and can be scheduled at regular intervals, much like the foot examination for a patient with diabetes.
But, never assume what is heard is actually understood. That emphasizes the concepts of “hear back” and “teach back” which we have stressed in our columns on health literacy and numeracy. (“Hear back” is obviously also critical in communication between healthcare professionals).
It’s time we recognize the high prevalence of hearing impairment and identify it early so that we can ensure we communicate with our patients in a meaningful way that will help avoid some of the unwanted consequences noted above.
Some of our columns on the impact of hearing loss:
Schulmeister L. Cancer Treatment to the Wrong Patient: Why Does This Still Happen? Oncology Nursing News 2018; March 8, 2018
Lin HW, Mahboubi H, Bhattacharyya N. Self-reported Hearing Difficulty and Risk of Accidental Injury in US Adults, 2007 to 2015. JAMA Otolaryngol Head Neck Surg 2018; Published online March 22, 2018
Simpson AN, Simpson KN, Dubno JR. Healthcare Costs for Insured Older U.S. Adults with Hearing Loss. Journal of the American Geriatrics Society 2018; First published: 24 May 2018
Chang JE, Weinstein B, Chodosh J, Blustein J. Hospital Readmission Risk for Patients with Self‐Reported Hearing Loss and Communication Trouble. J Am Geriatr Soc 2018; First published: 05 October 2018
Mahmoudi E, Zazove P, Meade M, et al. Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss. JAMA Otolaryngol Head Neck Surg 2018; Published online April 26, 2018
Wallhagen MI. Hearing Aid Use and Health Care Costs Among Older Adults. JAMA Otolaryngol Head Neck Surg 2018; Published online April 26, 2018