Last updated
Boothless Audiometry
Share PrintHearing loss and tinnitus are by far the most prevalent service-connected disabilities among American veterans, according to the VA's Office of Research and Development. Conventional audiology clinics require sound booths for audiometric assessments. Sound booths are not available at every VA location. This creates barriers to access as some veterans do not have the time or ability to drive long distances for audiology services. Implementing boothless audiometry in community-based outpatient clinics is more feasible and cost-effective than using a bulky, costly sound booth as it can be conducted in a quiet room, ideally equipped with acoustic panels and carpeting, utilizing the same audiometric equipment as the conventional model. Veterans' quality of life is improved by offering boothless audiology services in the outpatient clinic settings. They are better able to communicate with family and friends.
Origin:
February 2020, Alexandria VA Medical Center (Alexandria, Louisiana)
Adoptions:
2 successful, 1 in-progress
Awards and Recognition:
VHA Shark Tank Finalist, Diffusion of Excellence Promising Practice, VHA Shark Tank Winner
Partners:
Diffusion of Excellence
Recent Updates
Overview
Problem
The lack of audiology services at local VA clinics is a barrier for many veterans to receive convenient and timely hearing healthcare. Audiology has largely been prevented from having a presence in many outpatient clinics due to space and building limitations, for example, modular structures that cannot hold heavy soundproof booths. Tele-audiology or commun
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The lack of audiology services at local VA clinics is a barrier for many veterans to receive convenient and timely hearing healthcare. Audiology has largely been prevented from having a presence in many outpatient clinics due to space and building limitations, for example, modular structures that cannot hold heavy soundproof booths. Tele-audiology or community care is often the only option available.
Tele-audiology requires additional equipment and personnel, and scheduling is more complex. The telehealth model requires a telehealth cart, each of which costs more than $92,000 per cart, extensive training of additional telehealth technicians, space at two VA locations, and investment in technology infrastructure. Some telehealth sites also include a sound booth, with costs ranging from $16,000 for a single-walled to $69,000 for a double-walled booth. The telehealth modality reduces veterans' travel times; however, it does not increase access or improve wait times. One provider can only see so many veterans per day, whether the service is rendered through telehealth, VVC, telephone, etc.
Veterans can elect to see a community care provider when telehealth is the only modality of care offered at their nearest VA site. These appointments require a great deal of resources from VA personnel and are more costly to the VA. A hearing evaluation, hearing aid fitting, and three follow up appointments provided through a private practice provider cost the facility approximately $1500 per veteran. Five visits within the VA would cost approximately $175 salary dollars.
Boothless audiometry is a streamlined approach for offering audiology services at the community-based clinics. Clinic operations are more efficient, it reduces costs, and improves the quality of care. Many veterans utilize the VA solely for hearing healthcare. We believe if these veterans have a great experience in audiology, they are more likely to consider using other VA services. Our goal is to give veterans the option to choose their local VA clinic to receive quality hearing healthcare for life. See more
Tele-audiology requires additional equipment and personnel, and scheduling is more complex. The telehealth model requires a telehealth cart, each of which costs more than $92,000 per cart, extensive training of additional telehealth technicians, space at two VA locations, and investment in technology infrastructure. Some telehealth sites also include a sound booth, with costs ranging from $16,000 for a single-walled to $69,000 for a double-walled booth. The telehealth modality reduces veterans' travel times; however, it does not increase access or improve wait times. One provider can only see so many veterans per day, whether the service is rendered through telehealth, VVC, telephone, etc.
Veterans can elect to see a community care provider when telehealth is the only modality of care offered at their nearest VA site. These appointments require a great deal of resources from VA personnel and are more costly to the VA. A hearing evaluation, hearing aid fitting, and three follow up appointments provided through a private practice provider cost the facility approximately $1500 per veteran. Five visits within the VA would cost approximately $175 salary dollars.
Boothless audiometry is a streamlined approach for offering audiology services at the community-based clinics. Clinic operations are more efficient, it reduces costs, and improves the quality of care. Many veterans utilize the VA solely for hearing healthcare. We believe if these veterans have a great experience in audiology, they are more likely to consider using other VA services. Our goal is to give veterans the option to choose their local VA clinic to receive quality hearing healthcare for life. See more
Images
Cost of audiology community care referrals for all VISNs
Solution
After experiencing the limitations inherent in the telehealth model of care, we realized it would be easier for veterans to have an audiologist on site. This was accomplished by relocating a full-time employee and moving existing equipment from the main hospital into the community outpatient clinic. Two key elements of the technology used for tele-audiology,
...
After experiencing the limitations inherent in the telehealth model of care, we realized it would be easier for veterans to have an audiologist on site. This was accomplished by relocating a full-time employee and moving existing equipment from the main hospital into the community outpatient clinic. Two key elements of the technology used for tele-audiology, (noise reducing headphones and an ambient noise assessor device), make it possible to establish a full service boothless audiology clinic.
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Images
Veteran, Stacie Moore, completing audiology assessment at the Ft. Johnson VA clinic. Photographer: Gary Kelly
Results
Our practice places an audiologist in the community-based outpatient clinics utilizing the boothless audiometry protocol. This allows veterans to have access to hearing healthcare closer to home, reducing both travel and wait times and subsequently improving the Veteran experience.
The boothless audiometry protocol embodies the elements of human centered ... Our practice places an audiologist in the community-based outpatient clinics utilizing the boothless audiometry protocol. This allows veterans to have access to hearing healthcare closer to home, reducing both travel and wait times and subsequently improving the Veteran experience.
The boothless audiometry protocol embodies the elements of human centered design. Veterans who are claustrophobic, use a wheelchair, or are transported via stretcher can be accommodated, making it a more comfortable and pleasant experience for the veteran. Implementation is relatively simple as it requires less equipment and infrastructure, less maintenance, and it reduces administrative workload. An audiologist located in the local clinic increases access to quality audiology services within the VA. All aspects of boothless audiometry provide the appropriate solution for the veteran's desired outcome, i.e. convenient and timely access to quality care. See more
The boothless audiometry protocol embodies the elements of human centered ... Our practice places an audiologist in the community-based outpatient clinics utilizing the boothless audiometry protocol. This allows veterans to have access to hearing healthcare closer to home, reducing both travel and wait times and subsequently improving the Veteran experience.
The boothless audiometry protocol embodies the elements of human centered design. Veterans who are claustrophobic, use a wheelchair, or are transported via stretcher can be accommodated, making it a more comfortable and pleasant experience for the veteran. Implementation is relatively simple as it requires less equipment and infrastructure, less maintenance, and it reduces administrative workload. An audiologist located in the local clinic increases access to quality audiology services within the VA. All aspects of boothless audiometry provide the appropriate solution for the veteran's desired outcome, i.e. convenient and timely access to quality care. See more
Images
Veterans' feedback
Metrics
- The analysis of metric data collected demonstrates that having audiologists located at the outpatient clinic locations improves access to care. Veterans find the services easy to access, feel they are of high quality, and are satisfied with their visits. FY2020 Audiologist was rated above national average for all measures on the Patient Experience Survey, (overall provider rating, communication, and overall satisfaction).
Diffusion tracker
Does not include Clinical Resource Hubs (CRH)
Multimedia
Images
V-Signals data from the implementation sites from November 1, 2020 to September 5, 2024: Ease/Simplicity 97.1%; Quality 94.9%; Employee Helpfulness 96.4%; Satisfaction 96.4%; Confidence/Trust 92%
Implementation
Timeline
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30 to 90 Days
The timeframe for implementation will vary depending on resources available at the adopting site. The Alexandria Healthcare System was able to start two full-service audiology clinics at two separate sites within 8 months. The first discussion began at the Director's all employee town hall meeting in February 2020. If not for the COVID-19 pandemic, the boothless audiometry clinics would have been ready within four months. Our healthcare system blazed the trail by bringing veterans hearing healthcare to their local clinics, and even a pandemic did not stop us.
Departments
- Audiology and speech
- Biomed
- Administration
- Building management
- Information technology
Core Resources
| Resource type | Resource description |
|---|---|
PEOPLE |
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PROCESSES |
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TOOLS |
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Files
- How to Enable ANA How to Enable ANA
- ANA Patient Setup ANApatientsetup
Risks and mitigations
| Risk | Mitigation |
|---|---|
| Time and funding risks | Time risks include administrative time which takes away from clinic duties. To mitigate the time related risks, support personnel such as audiology technicians can be used to supplement care. Funding risks include the hiring of full-time audiologist and audiology technician. This cost will be mitigated through reducing the number of veterans that are being sent out to community care. When veterans can choose the VA as an option, they are able to receive hearing healthcare for a lifetime (no need for renewals of community care eligibility). It costs less for the VA to hire a full-time audiologist than it does to pay a community care audiologist. |
Contact
Comment
Comments and replies are disabled for retired innovations and non-VA users.
Email shannon.wise@va.gov with questions about this innovation.
About
Origin story
At the beginning of the day, preparing for clinic, you notice the veteran commuted from the same small town as you did. Realizing there is a local VA outpatient clinic in this town, you begin to wonder why this appointment could not have been completed at that site. According to engineering, the outpatient clinic building cannot even support a treadmill, so
...
At the beginning of the day, preparing for clinic, you notice the veteran commuted from the same small town as you did. Realizing there is a local VA outpatient clinic in this town, you begin to wonder why this appointment could not have been completed at that site. According to engineering, the outpatient clinic building cannot even support a treadmill, so a large heavy sound booth is likely out of the question. The other option would be tele-health services, which would entail the purchase of an expensive tele-health cart, additional technology infrastructure, and implementation of complicated scheduling efforts. Then a lightbulb comes on! You realize all the equipment in your office can be used at the facility without a sound booth or a tele-health cart. All that is needed is a team of innovators willing to "think outside the booth."
Original team
Dr. Jessica Magro
Audiologist
Dr. Shannon Wise
Audiologist
Super idea! Have a perfect site in mind to implement this and have some interest from the Director.
This is the future of CBOC audiology, 100% on board with this approach.
Congratulations, Drs. Shannon Wise & Dr. Jessica Magro! Looking forward to seeing more adoptions of your innovation of Bootless Audiometry! Excited for our veterans and AVAHCS, Way to Go Ladies!