Inter-professional collaboration to improve outpatient attendance rates on a cochlear implant aural rehabilitation programme

Abstract

Background: The cochlear implant (CI) programme at Changi General Hospital started in 2010. As the number of patients gradually increased over the years, a review of attendance rates from 2010 to 2016 showed that CI patients were not compliant in attending post-surgical aural rehabilitation sessions. A significant number of no-shows or appointment cancellations without rescheduling suggest that patients may not be motivated enough to go through aural rehabilitation. Hence, it was hard to evaluate clinical outcomes, which was demoralising for both the patient and health-care professionals involved. As transdisciplinary care is often involved in the aural rehabilitation process, we reviewed the existing CI clinical pathway to identify gaps in services, and with better fostering of inter-professional collaboration (IPC) in 2017, we compared the difference in outpatient aural rehabilitation attendance rates for patients seen before and after 2017. Methods: A retrospective review was undertaken of the outpatient administrative system to look at appointment cancellation rates before and after IPC for CI patients undergoing post-surgical aural rehabilitation from 2010 to 2019. A paired-sample t-test of significance was used, with the level of significance set at p=0.05. Problem analysis using the Problem, Intervention, Comparison, Outcomes framework helped in identifying the possible reasons for non-compliance with aural rehabilitation attendance. Inter-professional education among audiologists, otologists and speech therapists allowed for a close-knit IPC. Results: There were 78 patients with CIs from 2010 to 2019. Of these, 46 patients were implanted between 2010 and 2016, and 32 were implanted after IPC was introduced in 2017. The median cancellations rates were significantly reduced from 23% to 15%, with a p-value of 0.00. Days to switch-on and aural rehabilitation, number of appointment cancellations and total number of individual visits were significant independent predictors of the percentage of cancellations in regression analysis. Conclusion: Future studies are warranted to see if IPC can indirectly drive clinical outcomes, given that IPC encouraged better compliance with aural rehabilitation attendance post CI. It is imperative to have IPC in this dynamic health-care landscape with increasing complexities. IPC cannot be achieved without a close-knit relationship among the relevant health professionals.