Newborn hearing screening programme standards: valid for data collected from 1 April 2022
Updated 23 February 2022
Applies to England
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NHSP-S01: coverage
Description
The proportion of babies eligible for newborn hearing screening for whom the screening process is complete by less than 4 weeks (28 days) corrected age (in services which provide a hospital model – well babies) and neonatal intensive care unit (NICU) babies or by less than 5 weeks (35 days) corrected age (in services which provide a community model - well babies).
Rationale
To provide assurance that screening is offered to all eligible babies.
Definition
Numerator: number of eligible babies (for whom the offer is accepted) with a conclusive screen result recorded, or a screening outcome set by less than 4 weeks (28 days) (hospital model) or by less than 5 weeks (35 days) (community model) of date of birth or corrected age if born less than 40 weeks gestation.
A screening outcome is set when one of the following outcomes is entered in to the newborn hearing screening programme (NHSP) national IT system:
- clear response (CR) - no follow-up required; targeted follow-up required
- no clear response (NCR) - bilateral referral, unilateral referral
- incomplete - equipment malfunction, equipment not available, baby unsettled, screening contraindicated
Denominator: number of eligible babies born in the reporting period whose mother was registered with a GP practice in the clinical commissioning group (CCG), or (if not registered with any practice) resident in the area covered by the provider NHSP site or CCG area. This includes:
- well babies
- NICU babies
This excludes:
- any baby who died before screening could be completed
- well and NICU babies that have not reached 4 weeks (28 days) (hospital model) or 5 weeks (35 days) (community model) from date of birth or at the time of the report
- babies born in England who have had their record transferred electronically to Wales
- babies born in Wales who have had their record transferred electronically to England
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 98.0%.
Achievable level: greater than or equal to 99.5%.
Caveats
The following babies are included in the denominator but may not be screened by the NHSP and therefore are not included in the numerator. These babies should be accounted for and the reason explained in the commentary as mitigations against performance thresholds. They are:
- babies who have attained the required age (described above) but whose screening was delayed because they are not well enough
- babies who are eligible for screening but were screened in other countries (including Northern Ireland, Scotland and Wales (where their record has not been electronically transferred))
- babies born in US Air Force bases
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
This standard is also the key performance indicator NH1.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
KPI data is published quarterly and standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.
NHSP-S02a: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1) - hospital model
Description
The proportion of well babies in services providing a hospital model who do not show a clear response in both ears at the first screening test AOAE1.
Rationale
To provide assurance that the test is correctly identifying babies who require further screening tests. The test outcome can be influenced if test conditions and screener technique are optimised.
Definition
Numerator: number of well babies who do not show a clear response in both ears at AOAE1.
The possible outcomes at AOAE1 are:
- CR/CR
- NCR/NCR
- NCR/CR
- CR/not complete (NC)
- NCR/NC
- CR/not done (ND)
- NCR/ND
- NC/NC
- NC/ND
The numerator includes all combinations except CR/CR.
Denominator: number of well babies born in the reporting period who have an AOAE1 screening test.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: less than or equal to 27.0%.
Achievable level: less than or equal to 20.0%.
Caveats
None.
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
Standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.
NHSP-S02b: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1) - community model
Description
The proportion of well babies in services providing a community model who do not show a clear response in both ears at the first screening test (AOAE1).
Rationale
To provide assurance that the test is correctly identifying babies who require further screening tests. The test outcome can be influenced if test conditions and screener technique are optimised.
Definition
Numerator: number of well babies who do not show a clear response in both ears at AOAE1.
The possible outcomes at AOAE1 are:
- CR/CR
- NCR/NCR
- NCR/CR
- CR/NC
- NCR/NC
- CR/ND
- NCR/ND
- NC/NC
- NC/ND
The numerator includes all combinations except CR/CR.
Denominator: number of well babies born in the reporting period who have an AOAE1 screening test.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: less than or equal to 14.0%.
Achievable level: less than or equal to 12.0%.
Caveats
None.
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
Standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.
NHSP-S03a: test: referral rate to audiological assessment - hospital model
Description
The proportion of babies in services providing a hospital model who require immediate referral for audiological assessment.
Rationale
To provide assurance that babies with a screening outcome that indicates an immediate referral are appropriately referred for audiological assessment.
Definition
Numerator number of babies who receive a no clear response result in one or both ears at automated auditory brainstem response (AABR) or other outcome that requires an immediate referral for audiological assessment.
The screening outcomes in the NHSP national IT system which require an audiological assessment are:
- NCR at AABR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled, screening contraindicated, lack of service capacity
Denominator: number of eligible babies born in the reporting period who have a screening test date or for whom a screening outcome is recorded on the NHSP national IT system. This excludes babies with a screening outcome set as incomplete - appointments missed, deceased, declined screen, late entry, lost contact, out of screening coverage or consent withdrawn.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than 2.0% to less than or equal to 2.8%.
Achievable level: greater than or equal to 0.5% to less than or equal to 2.0%.
Caveats
None.
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
Standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.
NHSP-S03b: test: referral rate to audiological assessment - community model
Description
The proportion of babies in services providing a community model who require immediate referral for audiological assessment.
Rationale
To provide assurance that babies with a screening outcome that indicates an immediate referral are appropriately referred for audiological assessment.
Definition
Numerator: number of babies who receive a no clear response result at AABR in one or both ears or other outcome that requires an immediate referral for audiological assessment.
The screening outcomes which require a diagnostic audiological assessment in the NHSP national IT system screening are:
- NCR at AABR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled, screening contraindicated, lack of service capacity
Denominator: number of eligible babies born in the reporting period who have a screening test date or for whom a screening outcome is recorded on the NHSP national IT system. This excludes babies with a screening outcome set as incomplete - appointments missed, deceased, declined screen, late entry, lost contact, out of screening coverage or consent withdrawn.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than 1.3% to less than or equal to 1.6%.
Achievable level: greater than or equal to 0.5% to less than or equal to 1.3%.
Caveats
None.
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
Standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.
NHSP-S04: referral: time from screening outcome to first offered appointment for audiological assessment
Description
The proportion of babies requiring immediate referral for audiological assessment who are offered a first appointment in audiology that is in the specified timescale.
Rationale
To provide assurance that babies who require immediate referral for audiological assessment are offered a first appointment in audiology that enables attendance in the specified timescales in line with NHSP-S05. An offer of a first appointment should be made in clinically relevant timescales to allow for maturation of the ABR response (see the introduction to Newborn hearing screening supporting information).
Definition
Numerator: number of babies offered a first audiological assessment appointment following a conclusive screen result at AABR or a screening outcome set by:
- less than 4 weeks (28 days)
- less than 4 weeks (28 days) corrected age if born less than 40 weeks gestation
Denominator: number of babies born in the reporting period who have a no clear response result in one or both ears at AABR or other outcome that requires a referral for audiological assessment. This excludes babies who died before they could attend their audiological assessment.
The screening outcomes that require a diagnostic referral in the national IT system for newborn hearing screening are:
- NCR at AABR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled, screening contraindicated, lack of service capacity
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 97.0%.
Achievable level: greater than or equal to 99.0%.
Caveats
The following babies are included in the denominator but may not be offered follow-up in England and therefore are not included in the numerator. These should be accounted for and the reason explained in the commentary as mitigations against performance thresholds:
- babies who are too unwell to proceed with the test
- babies whose follow-up appointment is in another country
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
Standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.
NHSP-S05: diagnosis or intervention: time from screening outcome to attendance at an audiological assessment appointment
Description
The proportion of babies requiring immediate referral who are brought for an audiological assessment appointment in the required timescale.
Rationale
To provide assurance that opportunities for intervention for babies who require an immediate referral for audiological assessment are maximised by attending audiology in the required timescale.
Definition
Numerator: number of babies who were brought for audiological assessment appointment following a conclusive screen result at AABR or a screening outcome set by:
- less than 4 weeks (28 days)
- less than 4 weeks (28 days) corrected age if born less than 40 weeks gestation
Denominator: number of babies born in the reporting period who have a no clear response result in one or both ears at AABR or other outcome that requires a referral for audiological assessment. This excludes babies who died before they could attend their audiological assessment.
The screening outcomes that require a diagnostic referral in the NHSP national IT system are:
- NCR at AABR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled, screening contraindicated, lack of service capacity
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Acceptable level: greater than or equal to 90.0%.
Achievable level: greater than or equal to 95.0%.
Caveats
The following babies are included in the denominator but may not attend follow-up in England and therefore are not included in the numerator. These babies should be accounted for and the reason explained in the commentary as mitigations against performance thresholds:
- babies who are too unwell to proceed with the test
- babies whose follow-up appointment is in another country
Providers need to be able to demonstrate follow-up of those who did not attend or were not not brought, in accordance with local policy.
Data collection and reporting
Data source: NHSP national IT system.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from the NHSP national IT system.
Reported by: not applicable as extracted from the NHSP national IT system.
Published by: local newborn hearing screening provider.
This standard is also the key performance indicator NH2.
Reporting period
Screening year in which the baby was born (1 April to 31 March).
KPI data is published quarterly and standards data is published annually.
Data extraction dates: 15 September, 15 December, 15 March, 15 June.
Review dates
Date standard introduced: 1 April 2016.
Date standard last updated: effective from April 2022.