Staffing and structure for paediatric audiology services in hospital and community units.

The component functions of a paediatric audiology service are outlined on the basis of the main broad categories of patient and their requirements, as seen from a 'good practice' standpoint; a service structure is offered in terms of patient flow. This leads to a distinction between the small, specifically medical requirement, and the large, specifically audiological testing requirement. Indications are given of the scale of audiology requiring to be done by community staff not specializing in audiology. Notional incidence figures (and acceptable screen failure rates) allow the number of audiological posts or sessions required for screening and related community paediatric audiology work to be estimated per million population served. This totals about 9.75 FTE professional posts of varying grades per million population plus 1.5 FTE support, but in nearly all circumstances there will be many more incumbents than this, each with diverse other duties. The recommended staffing of audiologists doing hospital-based assessment and rehabilitation work and requiring specialized audiology training totals about 7.0 full-time equivalent (FTE) audiology posts and 2.5 support posts in a hospital paediatric audiology department, per million population; this is above the currently prevailing level of provision. The resource requirements would be raised by the widespread introduction of a non-standard screen (other than for the standard 6 to 9 month screen and the school-entry screen) by about 40% for community services and 15% for consequential increases in hospital services. In hospital units, the staffing will usually be interleaved with that of adult audiology, even where the served population may be large enough (e.g. 0.5 million, three to four paediatric audiology staff) to make a separate section worthwhile. In community units, there does not appear to be a particularly good rationale for community doctors specializing full-time in audiology, although some medical staff time is needed to undertake the specifically medical components. A partial degree of specialization among health visitors (or at least greater audiological training and experience) would probably achieve better performance of screens and simplify the attainment and maintenance of testing standards. Activities in hospital and community units have strong mutual implications: adding an intermediate-age screen to the established first-year and school-entry screens, and adding an at-risk neonatal screen would together increase consequent demands upon hospital paediatric audiology about 35%, although in neither case would the screening activity itself be undertaken in the hospital audiology unit.(ABSTRACT TRUNCATED AT 400 WORDS)