When Patients "Screen In"

Over referring patients is always acceptable and certainly preferable to under referring, and is necessary for any screening procedure. But the provider’s clinical judgment is still required.

At Children’s Hospital Boston, providers were told they were not required to refer anyone based on the results of the scoring algorithm. For example, if a parent cited a predictive concern but the provider was confident that the child was on-target developmentally, then close follow up without immediate referral was acceptable to the practice. In the months following implementation, providers maintain different approaches to referral, with some following the PEDS scoring algorithm more strictly than others.

Such a flexible and well-communicated policy helped decrease initial resistance and increased the success of the program.

Remember that:

  • Children who are not developing typically in your estimation should be referred, regardless of parent survey answers.
  • Parent concerns about behavior such as tantrums and toileting are addressed with provider counseling, per the PEDS referral algorithm.
  • Clinical care is improved with use of validated tools.