How to run an effective Baha programme
by Steve Worrollo, Maxillofacial Prosthetics Manager, Queen Elizabeth Hospital, Birmingham
The key to a successful Baha programme starts with a multidisciplinary team. Running and maintaining a dedicated service is a complex business which grows more complicated as the number of patients increases.
There needs to be a full team in place, with ENT surgery and full audiological support
before setting up a programme, and unless there is a sufficient demand for a minimum 10-15 patients per year, then it is difficult to achieve and maintain the skills required and
justify the outlay necessary to set up and run a cost effective service.
Teamwork
Patient selection is of vital importance and the teamwork between audiology and the surgeon is fundamental in identifying the potential benefits from a Baha. As thresholds and criteria changes in SSSD™ and benefits of bilateral aiding gain evidence, careful evaluation of results and outcomes become invaluable in future patient treatment options.
Sometimes it will be obvious that someone will benefit from a Baha, but in borderline cases, the question to ask is, is it enough to warrant the procedure? In these cases it is wise to trial the patient with a Baha Headband, which works in exactly the same way as an implanted Baha, and will give the patient an idea as to whether they will benefit from, and be comfortable with, a Baha, before committing to the surgical procedure.
Another important member of the team is the nurse specialist with their expertise in the management of the wound and any potential skin problems around the abutment.
Funding
BAHA funding is recovered on an individual cost-per-case basis via the patient’s
Primary Care Trust (PCT). It is covered under the National Tariff as an ENT surgical procedure. This, however, is insufficient to cover the expenditure incurred by purchase of the surgical components and the aid itself. This is recovered separately under exclusions, which allows for a ‘Top-up’ for the hardware, implant, processor etc.
Lifelong rehabilitation
Far more important than the initial funding for the Baha surgery is the lifelong rehabilitation programme which any patient on a Baha programme will require. This can be a problem if ongoing maintenance and replacement aids are not built into a programme’s planned expenditure. Every patient should be on a rolling maintenance programme, and the Trust will need to apply to the PCT for funding each year. As the number of patients increases, the more funding is needed to maintain a “snowballing” number of aids that need repairing, replacing or upgrading.
The “Faitec” (Facial implants and technology programme) was initially set up at the Queen Elizabeth Hospital, Birmingham in 1988. It was a joint Baha and facial prosthetics programme for adults and children, where the technology of osseointegration was unutilised for both procedures. This was a major advance on existing methods and allowed greatly improved patient outcomes and satisfaction.
