Same-Day Patient Consultation and Cochlear Implantation: Innovations in Patient-Centered Health Care Delivery

Abstract

Objective: To develop and implement a streamlined, patient-centered service delivery model for patients referred for cochlear implantation (CI) at a high-volume academic center. Patients: CI candidate adults. Interventions: CI, implementation of new CI delivery model. Main Outcome Measures: Referral-to-surgery time, patient travel burden. Results: Data from 206 adults that underwent CI were used to develop a process map of the initial operational state from referral date to day of surgery (referral-to-surgery time). The initial referral-to-surgery time was 136 days on average, yet the average total work time by all involved providers was 17.6 hours. Prolonged wait times were associated with the following preoperative tasks: appointment scheduling, insurance approval, device ordering and shipment, and surgical scheduling. Patients traveled to the institution on at least two occasions for appointments. A new bundled, patient-centered CI delivery model was developed to address prolonged wait times, travel burden, and process inefficiencies. The new model implemented an interactive electronic medical record, coordinated appointments with same-day surgery, and stocked device inventory to reduce the referral-to-surgery time to 24 days—an improvement of 112 days. In the new model, new patient consultation and surgery were completed in one day, reducing the patient travel burden to the institution. Conclusions: The new CI program demonstrates that delivery innovations can have a substantial impact on measures of patient convenience and experience, and that these results are achievable without new technologies or changes in medical management. With a focus on patient-centered design, health care delivery models can be augmented to increase value for patients.

Barriers to Adult Cochlear Implant Care in the United States: An Analysis of Health Care Delivery

“…For adult patients, presurgical workup (surgical evaluation, CI audiometric evaluation, anesthesia clearance, and imaging), CI surgery, and postoperative aural rehabilitation and programming require multiple appointments, up to 10, when uncoordinated. 15 68 Aside from issues with convenience, the burden associated with these appointments can be an insurmountable barrier for patients requiring childcare, time off from work, and transportation assistance. 15 Importantly, prior work has demonstrated considerable differences in utilization and access across patient geographic distribution, socioeconomic status, and age groups.…”

“…15 68 Aside from issues with convenience, the burden associated with these appointments can be an insurmountable barrier for patients requiring childcare, time off from work, and transportation assistance. 15 Importantly, prior work has demonstrated considerable differences in utilization and access across patient geographic distribution, socioeconomic status, and age groups. 4 18 48 49 As most insurance plans cover CIs for patients meeting criteria, geographic and informational barriers continue to limit access to care.…”

“…From a patient perspective, the process that spans diagnosis of hearing loss to rehabilitation involves a spectrum of individual, locoregional, and systemic barriers which can discourage appropriate referral and treatment. 15 16 An evaluation of the patient experience via a detailed analysis of the hearing health care delivery model can systematically expose the barriers associated with each aspect of the CI care delivery process ( Fig. 1 ).…”

Perioperative Nursing Care of the Patient Undergoing a Cochlear Implant Procedure

“…• CI functionality and the device's product details, 11 • what to expect the day of surgery, 12 • the perioperative process (eg, insertion of an IV line, hair clipping at the surgical site), 5 • planned dressings and drainage tubes, 5…”

“…The surgeon and nurse should provide preoperative education to the patient and his or her family, including information on CI functionality and the device’s product details, 11 what to expect the day of surgery, 12 the perioperative process (eg, insertion of an IV line, hair clipping at the surgical site), 5 planned dressings and drainage tubes, 5 postanesthesia care, potential postoperative complications, 5 side effects (eg, bruising, edema, loss of sensation at the surgical site) that will gradually subside, 5 and rehabilitation and the follow-up process after implantation 5 …”