Inpatient Audiograms: A Mixed Methods Study Examining Clinical Decision Making, Financial Analyses, and Audiologist Perspectives.

Abstract

Objective: Evaluate inpatient audiometry on clinical decision-making. Assess stakeholder perspectives on the practice of inpatient audiometry and financial impact.

Study design: This is a mixed methods study utilizing retrospective chart review, a focus group, and financial analyses.

Setting: Academic tertiary referral center.

Methods: Included subjects were adults (18+) admitted from 2015 to 2022 who received an inpatient audiogram (n = 302). A binary assessment of whether audiograms impacted inpatient clinical management was determined. Financial analyses estimated the cost of audiograms. An audiology focus group was conducted.

Results: The average age was 51 years. Thirty-nine percent were female. Seventy percent of inpatient audiograms were associated with Otolaryngology consultation. Inpatient audiograms were performed an average of 3.6 days after request (0-47 days, 90th percentile 8.2 days). Forty-nine percent were performed within 1 day. Twenty-three percent were performed for acute hearing loss. Ototoxic monitoring was the most frequent indication (15%). Sixty-two percent of audiograms did not impact the initiation or withholding of treatment. Inpatient testing results in a 63% increase in cost over outpatient. Audiologists endorsed challenges with equipment, patient-level factors, and system-level challenges.

Conclusion: Inpatient audiometry is resource-intensive without significant data examining the impact and clinical utility. In most cases, inpatient audiometry is not used in the decision to withhold or deliver treatment and may cost 63% more than outpatient audiograms. While inpatient audiometry has a critical role in appropriate settings, system optimization and guidelines are necessary. Outpatient audiograms may suffice for the majority of otologic consults in combination with a thorough history and physical exam. Additional study across institutions with variable practice would be beneficial to establish broader recommendations.