January 9, 2020

Same-day cochlear implant surgeries reduce travel burden, wait times

VUMC is testing an optimized cochlear implant delivery model that offers patients hearing tests, radiologic scans, surgical consultation, device selection and outpatient surgery all on the day of their initial visit.

by Kelsey Herbers

Nearly 20 years ago, Sue Baskette woke up with a loss of hearing in her good ear.

After years of struggling with hearing aids, she asked her doctor in Johnson City, Tennessee, whether she might be a candidate for cochlear implants. She was referred to David Haynes, MD, professor of Otolaryngology, Neurosurgery and Hearing and Speech Sciences at Vanderbilt University Medical Center.

Because of her distance from VUMC, Baskette was the perfect candidate for a pilot study testing an optimized cochlear implant delivery model — a new system that offers patients hearing tests, radiologic scans, surgical consultation, device selection and outpatient surgery all on the day of their initial visit.

Sue Baskette of Johnson City, Tennessee, recently received same-day cochlear implant surgery at Vanderbilt.

“After Dr. Haynes called me and talked to me about the program, I thought, ‘How exciting to be involved in that, because I’m 300 miles away,’” said Baskette. “I was treated maybe better than the queen of England. Dr. Haynes followed me through the audiology testing, he did the exam in his office and he was in pre-op with me. The next day, I headed back to Johnson City.”

Patients like Baskette are common at the Vanderbilt Bill Wilkerson Center, which operates the largest cochlear implant program in the country with an average of 300 surgeries annually. Patients travel from all parts of Tennessee and surrounding states, making multiple preoperative screenings and visits a challenge.

“Being in Middle Tennessee, we have a large catchment area. Thus, we have individuals making multiple long trips to Nashville,” said Rene Gifford, PhD, professor of Hearing and Speech Sciences and director of VUMC’s cochlear implant program. “For adults who are obvious cochlear implant candidates and do not have other medical conditions that could complicate surgery, offering same-day evaluation and surgery streamlines the journey to better hearing.”

Although cochlear implant technology has been around since the 1970s, utilization rates remain low. In the United States, only 5-7% of adults who need a cochlear implant receive one.

“We have an operation that restores hearing, but the complexity of getting hearing test after hearing test, finding a center that offers the surgery and making trips back and forth creates significant barriers for people to overcome. We wanted to make the process easier,” said Haynes.

Patients who are interested in same-day surgery can share previous audiologic test results from an outside facility prior to their visit to confirm candidacy. A surgery coordinator then coordinates back-to-back appointments with an audiologist, radiologist, anesthesiologist and surgeon. Patients receive advance educational materials to ensure surgery is the best option for them, and they can ask questions through telehealth consultations prior to their appointment.

On the day of their appointment, they arrive around 6 a.m., finish their screenings by lunchtime and have their surgery in the early afternoon. The visit typically ends around 5 p.m.

“Such a remarkable same-day service comes about because of remarkable professionals at the Vanderbilt Bill Wilkerson Center. Our coordinated cochlear implant program has many unique ingredients, from world-renowned clinical care in otology and audiology to exceptional research programs,” said Roland Eavey, MD, Guy M. Maness Professor and chair of Otolaryngology and director of the Vanderbilt Bill Wilkerson Center. “This same-day project took a few years of preparation in conference rooms working out such items as cost details and value stream mapping by members of the team. Besides being among the busiest cochlear implant centers, for select patients, our service is also the most efficient.”

Prior to the same-day option, referral-to-surgery time took an average of 136 days, often prolonged by multiple appointment scheduling and associated travel, insurance approval and device shipment. The new process, which keeps an inventory of devices onsite and works through insurance barriers in advance, reduced referral-to-surgery time to 24 days.

“We have the technology and capacity to make it easier for patients to receive care that doesn’t disrupt the rest of their lives by making them miss work or find child care,” said Ashley Nassiri, MD, MBA, an Otolaryngology resident who helped streamline the process. “I think we’re moving toward making high-quality academic health care more accessible for patients, regardless of their location.”

For more information on Vanderbilt’s hearing implant services, click here.