How do we decide on referrals in our audiometric tests?
Referral of some people to a specialist, or more likely in the first instance to a GP, will always be part of audiometric testing done in a workplace screening programme.
Referrals generally come up in Category 3 and Category 4 cases, or possibly in unilateral results. For me, how these are dealt with is a very important and is useful tool for distinguishing between the good service providers who clearly have a bit of knowledge and are looking at each result individually, and those who are simply pressing a 'go' button then saying little more than 'computer says fail, referral' if a Category 3 or Category 4 result comes up.
Unnecessary referral is not only a sign of shabby service and a screening technician who is frankly doing little more than a trained monkey could do, but it also causes the employer needlessly increased costs and the attendee pointless worry and wasted time.
How we manage ‘fails’ and referrals
The goal in our screening is tow-fold. Firstly to confirm that the noise safety programme in the workplace is working sufficiently well, and secondly to identify the case where the employee has a potential issue and flag that up so the employer knows what is needed from them and they can focus on them and not worry about the rest of the bulk of the people.
To help with this we introduced our own system of ‘informal' and ‘formal’ referrals. We did this so we could filter attendees into three groups for the employer rather than just referring larger blocks of people and highlight the small number of people the employer would benefit from spending time on following the screening. To this end, we have three groups of audiometric test results:
Those with no problems.
Those with a problem but chances are it is not noise related so the employer need not get involved in any subsequent action.
Those with a problem which has the potential to have an impact at work and which the employer should follow up on.
Informal audiometry referral
We would recommend an individual seeks further attention where their result is poor but is unlikely to be related to noise at work. So as some examples:
where there is sign of infection in the ear when we have a look with the otoscope
where they report pain or ear-ache,
where there is a lot of wax and the fail is marginal
where the loss is in one ear only unless their work generates more noise in one ear
where the loss is at frequencies which are unlikely to be involved in noise exposures
In cases like these we will recommend the individual seeks further examination, but in the report will tell the employer this has been done for the individual’s own health and the employer need not get involved in any follow-up.
As a back-up, we always tell the individual to go back to their employer if the follow-up examination identifies anything which may impact on their hearing.
Formal audiometry referral
This is used where the attendee ‘fails’ the test, where there is no supporting history for the loss, and where there is a chance it could be noise-related or could impact on their safety at work. In cases such as these we will include some information on the referral in the report and say that the employer should follow up on it. This way, the employer knows exactly what action is needed of them.