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Q Bulletin, Volume 1, No. 32 (Supplement 1), Jan - Dec 202412th National QA Convention, 8 %u2013 10 October 2024QLL-122Clinical Audit on %u201cREFER%u201d Rate of First Hearing Screening in Neonatal Unit in aTertiary CenterLee VY, Ang ELPaediatric Department, Hospital Tengku Ampuan Rahimah, SelangorINTRODUCTION:Partial Universal Hearing screening has been implemented in our centre since 2012. Our %u201cREFER%u201d rate(i.e. infants that did not pass their hearing screening) was higher compared to the benchmark rate of %u22644%set by the Joint Committee of Infant Hearing. This is a burden not only to the Audiology Department butalso to caregivers as many require a second outpatient screening. We aim to reduce the %u201cREFER%u201d rate offirst hearing screening of neonates admitted to neonatal wards.METHODOLOGY:Data for analysis were obtained from neonatal wards. Data from the year 2021 was analysed and the%u201cREFER%u201d rate was above the set standard. Discussions were held to identify possible factors leading tohigh %u201cREFER%u201d rate with implementation of new steps starting September 2022. Data was collected aftereach audit cycle and re-audit was carried out in cycles till set standards achieved.RESULTS:In the year 2021, 9274 newborns were screened with a %u201cREFER%u201d rate of 7.35%. The hearing screeningworkflows were compared among the wards and few issues were identified %u2013 a standardised workflowwas implemented in September 2022 and trained personnels were encouraged to perform bedsidescreening rather than bringing babies to a separate room. After the first cycle, %u201cREFER%u201d rate was still high8.5%; hence, new steps were taken including allocating specific time slots and to perform a repeatscreening prior to discharge since April 2023. %u201cREFER%u201d rate was reduced to 4% after the second cycle.DISCUSSION:After the second cycle, there was significant reduction in the %u201cREFER%u201d rate of first hearing screening.These results may help to improve the quality of hearing screening guidelines in our clinical practice.Regular review of the screening program is required to ensure sustainability of the results and also tofurther identify factors contributing to any unsatisfactory performance so that early identification ofhearing loss can become a reality.214 | Page