Quality and improvement: How well are we doing in the diagnostic process?

Ms Florencia Montes1

 1Sydney Children’s Hospital, Randwick, Artarmon, Australia



To share our Peer review system for quality monitoring and improvement.


In 2009 the NSW Department of Health conducted an evaluation of the SWISH program. The evaluation was an audit of screening only and did not include diagnostics at that stage. The outcome was very positive, with high levels of satisfaction. The screening rate has consistently been >99%.

So, how well are the diagnosticians doing and how are we ensuring quality?

The JCH position statement outlines that appropriate audiological and medical evaluations to confirm the presence of hearing loss should occur at no later than 3 months. Quality involves correct and timely diagnosis, obtaining enough information for appropriate management and referrals for further management and investigations, and parent’s satisfaction.

A systematic internal and external peer review system has been implemented at The Children’s Hospital Network, with the aim of reviewing most patient’s diagnostic results to ensure accurate diagnosis and also as a learning and improvement tool. This is in addition to sign off of waveforms at the time of diagnosis prior to providing families with results. We aim at including JPAC and John Hunter, and Canberra Hospital to have a state wide peer review system.

There are well established peer review programs internationally, a good example is the Welsh program. The system we have in place has some differences with other peer review systems, mainly the review is conducted by all audiologists in both clinics, locally in a fortnightly meeting and network monthly.


The benefits have been consistency across both sites, improvement in quality of traces and test efficiency, well received by participating audiologists, consensus in protocols. In addition, the knowledge that others will be perusing waveform results in detail has led to a more careful and considered approach to testing.


I’m a clinical diagnostic audiologist with 12 years experience in the diagnostic assessments of babies. I’m currently working at Sydney Children’s Hospital in Randwick