Using the MSTB-3 to improve consistency across sites

Mass Eye and Ear (MEE) is a specialty hospital with a robust Audiology department that annually serves approximately 60,000 patients across the lifespan, offering a broad spectrum of audiologic clinical services. Our hospital implants about 200 cochlear implants each year. To support this large patient population, we employ around 60 audiologists across 14 locations, with half specializing in cochlear implants and other audiologic services. Given the size of our department and staff, maintaining consistent clinician training, upholding quality of care, and ensuring uniform patient information and evaluations across locations and providers is an ongoing effort. This challenge is not unique to MEE and can affect clinics regardless of whether they are private practices or large hospital settings.

‍

One step we have taken to ensure consistency in clinician training and quality of care is the development of standardized clinic protocols and staff competencies. These protocols encompass both pre- and post-cochlear implant test batteries and candidacy criteria. Serving as a member of the MSTB-3 consensus panel provided me with a unique opportunity to review current evidence supporting clinical decision-making, compare MEE’s protocols with those of other experts nationwide, identify areas for re-evaluation and streamlining of MEE’s test batteries, and pinpoint gaps in evidence needing further research and focus. This process confirmed that MEE’s protocols mostly align with current evidence and MSTB-3 recommendations, including candidate referral guidelines, unaided audiometric testing, and the use of aided CNC scores for candidacy criteria.

‍

A key takeaway was the MSTB-3's redefinition of the best-aided condition and its recommendation to use AzBio +10 in the ear to be implanted. The MSTB-3 defines best-aided as “the test condition where the patient uses a HA that has been optimized for hearing loss in an individual ear”.  These recommendations and reference from the MSTB3 help reframe the concept of best-aided conditions for MEE audiologists and otologists and broadens candidacy criteria for individuals. Clinicians noted that this change confirms their perception of the patients they considered suitable implant candidates who did not previously meet candidacy criteria when best-aided was defined by the binaural test condition. The recommendations also support us in eliminating testing AzBio in the quiet condition for most patients, simplifying the workflow. Clinicians found the +10 condition to be a stronger indicator for pre-operative counseling, post-surgical performance, and insurance criteria. Additionally, the MSTB-3 also provides straightforward flowcharts that are easy to disseminate to providers and clarify testing protocols. This improves clinician training and consistency across providers.

‍

MEE also uses standardized cochlear implant report templates to ensure consistent documentation and communication with patients and referring providers. The MSTB-3 has led to improved documentation and helped to align various clinics on the information needed to create universal templates. Some facilities had innovative ways of phrasing or documenting results and recommendations. We have replaced our previous templates with these new MSTB-3 drafts, resulting in more comprehensive and simplified documentation for audiologists and streamlining our pre-operative pre-certification process. Overall, serving on the consensus panel was rewarding, and I believe all clinics could benefit from using the MSTB-3 to review their protocols and test batteries, ensuring consistent patient referral and evaluation regardless of where they seek hearing healthcare.

‍