Developmental Screening in the Outpatient Setting

In 2006 the American Academy of Pediatrics issued a statement recommending developmental screening using formal tools at 9, 18, and 30 months of age. Pediatricians require a formal tool for screening because practitioners are noted to miss 39% of patients who would qualify from referral to early intervention services without one. The overall aim of this project was to increase the rate of developmental screening at the 18 month well child visit using the Ages and Stages Questionnaire (ASQ) in a community health center (CHC).The pre-intervention rate was 0%, and we decided upon a goal of 90% of eligible patients to be screened. Chart audits were performed every 2 months and feedback was given to the physicians immediately. We began by running several PDSA cycles and completing a formal process map using LEAN methodology. Next the proposed model was reviewed by the clinic physicians and staff. We addressed anticipated barriers such as identifying methods to recognize the appropriate patients and incorporation of the process into the rooming protocol. The 18 month ASQ applies to 17-19 month olds so calendars with appropriate birth months were made and distributed to registration clerks. The medical assistants (MAs) daily scanned the physicians' schedules, identified eligible patients, and provided the list to the registrar. The registrar provided the ASQ to the parent at check-in allowing time for completion. MAs then collected and scored the forms, thus providing the physician with the ability to counsel parents about the results. After 2 months of the new process being in place, 33.3% of 17-19 month olds were screened. This increased to 64.3% at 4 months and 92.9% at 6 months, which has been sustained at above 92% for at least 6 more months with continued auditing every 2 months. In conclusion, we were able to implement a successful QI project in our clinic to improve the rate of developmental screening of 17-19 month old children using the ASQ. In the future, we plan to utilize a similar process towards developmental screening at different ages.