Newborn hearing screening programme standards: valid for data collected from 1 April 2018 to 31 March 2022
Updated 9 October 2024
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 4 weeks corrected age (hospital programmes – well babies, neonatal intensive care unit (NICU) babies) or by 5 weeks corrected age (community programmes - well babies).
Rationale
This standard is needed to provide assurance that screening is offered to parents of all eligible babies and that each baby (for whom the offer is accepted) has a completed screening outcome.
Definition
Numerator: number of eligible babies with a complete screen.
This is the number of babies for whom a decision about referral or discharge from the screening programmes is made within an effective timeframe and includes:
-
babies for whom a conclusive screening result was available by 4 weeks corrected age (hospital programmes - well babies, NICU babies) or by 5 weeks corrected age (community programmes - well babies)
-
babies referred to an audiology department because a newborn hearing screening encounter was inconclusive or contraindicated
The screening outcomes that comprise a complete screen are:
- clear response (CR) - no follow-up required
- CR - targeted follow-up required
- no clear response (NCR) - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled
- incomplete - screening contraindicated
Denominator: number of eligible babies born within the reporting period whose mother was registered with a GP practice within the clinical commissioning group (CCG), or (if not registered with any practice) resident within the area covered by the provider NHSP site or CCG area, excluding:
- any baby who died before screening could be completed
- babies that have not reached 4 weeks corrected age (hospital programmes - well babies, NICU babies) or 5 weeks corrected age (community programmes - well babies) at the time of the report
- babies born in England and have had their record transferred electronically to Wales
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Corrected age is used for babies born at less than 40 weeks gestation.
Coverage is defined as a screening outcome set on the national IT system for NHSP, accepting that the screen may be incomplete.
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 NHSP and therefore not included in the numerator. The following 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 by one of the other home countries (Northern Ireland, Scotland, Wales)
- babies born in US Air Force bases
Data collection and reporting
Data source: SMaRT4Hearing (S4H) national IT system for newborn hearing screening.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from S4H by national NHSP.
Reported by: not applicable as extracted from S4H by national NHSP.
Published by: local newborn hearing screening provider.
This standard is also the key performance indicator NH1.
Reporting period
Quarterly data to be collated between 2 and 3 months after each quarter end.
Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).
Review dates
Date standard introduced: April 2016.
Date standard last updated: March 2018.
NHSP-S02: test: well babies who do not show a clear response in both ears at automated otoacoustic emission 1 (AOAE1)
Description
Test performance.
Rationale
This standard is needed to monitor the performance of the screening test and to minimise harm.
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 who have any AOAE1 test.
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
Performance thresholds
Hospital programmes:
- Acceptable level: less than or equal to 27.0%
- Achievable level: less than or equal to 22.0%
Community programmes:
- Acceptable level: less than or equal to 15.0%
- Achievable level: less than or equal to 13.5%
This is a negative polarity standard which means a lower percentage is better.
The variation in thresholds shows that community programmes typically screen babies at a later age and therefore pass rates are higher.
Caveats
None.
Data collection and reporting
Data source: S4H, national IT system for newborn hearing screening.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from S4H by national NHSP.
Reported by: not applicable as extracted from S4H by national NHSP.
Published by: local newborn hearing screening provider.
Reporting period
Annual data collected by 30 June.
Review dates
Date standard introduced: April 2016.
Date standard last updated: April 2019.
NHSP-S03: test: referral rate to diagnostic audiological assessment
Description
Test performance.
Rationale
This standard is needed to monitor the performance of the screening test at the final result of the screen in order to minimise harm.
Definition
Numerator: number of babies that receive a no clear response result in one or both ears or other result that requires an immediate onward referral for audiological assessment.
The screening outcomes who require a diagnostic referral within the national IT system for newborn hearing screening are:
- NCR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled
- incomplete - screening contraindicated
Denominator: number of eligible babies with a complete screen. This is the number of babies for whom a decision about referral or discharge from the screening programme is made and includes:
- babies for whom a conclusive screening result was available
- babies referred to an audiology department because a newborn hearing screening encounter was inconclusive or contraindicated
We calculate performance by dividing numerator by denominator and multiplying by 100 to give a percentage.
The screening outcomes that comprise a complete screen within the national IT system for newborn hearing screening are:
- CR - no follow-up required
- CR - targeted follow-up required
- NCR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled
- incomplete - screening contraindicated
Performance thresholds
Hospital programmes:
- Acceptable level: less than or equal to 3.0%
- Achievable level: less than or equal to 2.0%
Community programmes:
- Acceptable level: less than or equal to 1.6%
- Achievable level: less than or equal to 1.3%
This is a negative polarity standard. This means a lower percentage is better.
The variation in thresholds reflects that community programmes typically screen babies at a later age and therefore pass rates are higher.
Caveats
None.
Data collection and reporting
Data source: S4H, national IT system for newborn hearing screening.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from S4H by national NHSP.
Reported by: not applicable as extracted from S4H by national NHSP.
Published by: local newborn hearing screening provider.
Reporting period
Annual data collected by 30 June.
Review dates
Date standard introduced: April 2016.
Date standard last updated: March 2018.
NHSP-S04: referral: time from screening outcome to offered appointment for diagnostic audiological assessment
Description
The proportion of babies with a no clear response result in one or both ears or other result that require an immediate onward referral for audiological assessment who are offered an audiological assessment appointment that is within the required timescale.
Rationale
To provide assurance that babies with a no clear response result in one or both ears or other result who require an immediate onward referral for audiological assessment, are referred for diagnostic audiological assessment in a timely manner.
Definition
Numerator: number of babies who receive a no clear response result in one or both ears or other result that requires an immediate onward referral for diagnostic audiological assessment who are offered an appointment that is within the required timescale.
Within the national IT system for newborn hearing screening a no clear response result is defined as the following screening outcomes:
- NCR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled
- incomplete - screening contraindicated
The required timescale is either within 4 weeks of screen completion or by 44 weeks gestational age. Corrected age is used for babies born at less than 40 weeks gestation.
Denominator: number of babies who receive a no clear response result in one or both ears or other result that requires an immediate onward referral for diagnostic audiological assessment.
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. The following 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 or who die between screen completion and the offer of a diagnostic audiological assessment appointment
- babies whose follow-up appointment is in another country
The threshold was previously set at 100% and should be regarded as a structural standard defined within the service specification. However, to focus attention on this, it will be included as a programme standard until performance improves.
Data collection and reporting
Data source: S4H, national IT system for newborn hearing screening.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from S4H by national NHSP.
Reported by: not applicable as extracted from S4H by national NHSP.
Published by: local newborn hearing screening provider.
Reporting period
Annual data collected by 30 June.
Review dates
Date standard introduced: April 2016.
Date standard last updated: March 2018.
NHSP-S05: diagnosis or intervention - time from screening outcome to attendance at an audiological assessment appointment
Description
The proportion of babies with a no clear response result in one or both ears or other result that require an immediate onward referral for audiological assessment who receive audiological assessment within the required timescale.
Rationale
To provide assurance that babies with a no clear response result in one or both ears or other result who require an immediate onward referral for audiological assessment receive diagnostic audiological assessment in a timely manner.
Definition
Numerator: number of babies who receive a no clear response result in one or both ears or other result that requires an immediate onward referral for diagnostic audiological assessment who attend an appointment within the required timescale.
Within the NHSP national IT system a no clear response result is defined as the following screening outcomes:
- NCR - bilateral referral, unilateral referral
- incomplete - baby or equipment reason, equipment malfunction, equipment not available, baby unsettled
- incomplete - screening contraindicated
The required timescale is either within 4 weeks of screen completion or by 44 weeks gestational age. Corrected age is used for babies born at less than 40 weeks gestation.
Denominator: number of babies who receive a no clear response result in one or both ears or other result that requires an immediate onward referral for diagnostic audiological assessment.
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. The following 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 or who die between screen completion and offer of diagnostic audiological assessment appointment
- babies whose follow-up appointment is in another country
Providers need to be able to demonstrate follow-up of those who did not attend as per local policy.
Data collection and reporting
Data source: S4H.
Responsible for data quality and completeness: local newborn hearing screening provider.
Responsible for submission: not applicable as extracted from S4H by national NHSP.
Reported by: not applicable as extracted from S4H by national NHSP.
Published by: local newborn hearing screening provider.
This standard is also the key performance indicator NH2.
Reporting period
Quarterly data to be collated between 2 and 3 months after each quarter end.
Deadlines: 30 September (Q1), 31 December (Q2), 31 March (Q3), 30 June (Q4).
Review dates
Date standard introduced: April 2016.
Date standard last updated: March 2018.