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Why don’t some parents return for a follow-up examination?

2012-09-04

A working group of the National Institute on Deafness and Other Communication Disorders identified several important factors regarding why some parents do not bring their child back for a follow-up examination. They concluded that the number of children who return for the follow-up examination could be increased if

  • Parents fully understood their child’s screening results,
  • Parents fully understood the importance of the diagnostic evaluation, and
  • Parents were provided with necessary contact and resource information.

A few of the most commonly cited reasons for the low response rate are included below, along with communication initiatives that you, the medical professional, can implement to help improve the outcome.

“With so many people involved in the process, it’s difficult to be sure that the information is being relayed to parents.”—Charles

  • Take responsibility This is particularly true if the child is sent to the neonatal intensive care unit (NICU). A NICU physician may not see the parents again until several days after the child is born, if ever. A person on the medical team should be responsible for understanding and being able to interpret and carefully explain to parents the infant’s screening results. It is extremely important that this individual be able to explain to parents why a follow-up examination is needed. Outdated wisdom that "parents can check back in a year to see if there is a change" is shortchanging children who could benefit from early intervention services.
  • Develop a protocol Develop a protocol to ensure that all parents receive the same information during their baby’s birth and hospital stay. The more consistent the procedure and message, the less likely that a family will leave the hospital without understanding the next steps they need to take and why. With shortened maternity stays, this protocol becomes even more critical.

“There’s no system in place to make sure that parents make and keep the follow-up appointment.”—Jocelyn

  • Obtain the family’s contact information Medical staff should check in with families after they leave the hospital to make sure they’ve taken their child to the diagnostic evaluation. To facilitate ongoing communication, ask families to complete a discharge questionnaire before they leave the hospital, including names, addresses, phone numbers, e-mail addresses, and any other useful contact information.
  • Connect the child with a "medical home" As soon as a child is born, the family should be linked to a "medical home," a term that, according to the American Academy of Pediatrics (AAP), refers to healthcare services that are coordinated, comprehensive, family-centered, and accessible, among other things. This centralized system makes it easier for medical staff to track a child’s medical visits, recognizing immediately from his or her records whether the follow-up examination has been completed. To learn more about the "medical home" concept, and how your role and the role of your staff would be affected, contact the AAP for possible training sessions in your state or region at www.aap.org.
  • Give office staff a lead role Office staff should help families navigate the healthcare system, which can be quite complicated for individuals who are unfamiliar with it or who have difficulty reading or understanding the English language. By providing easy-to-read checklists and contact information, volunteering to schedule the follow-up appointment, and checking in with families to make sure that the appointment has been kept, office staff can help provide the needed push to ensure that this important task is completed.
  • Offer broad-based institutional support When feasible, hospitals should develop a support structure that will help medical staff better perform their duties in this area. This might include:
    • modeling the hearing screening and diagnostic evaluation after an already-established program, such as metabolic screening;
    • integrating health information systems to ensure that each child’s records are readily available to all health professionals who need to access them; and
    • coordinating the billing for hospital services with the receipt of all follow-up information.

“There aren’t enough people or resources available to handle the screening and follow-up process.”—Miguel

  • Cross-train staff
    In communities where resources or staff are lacking, hospitals could cross-train medical staff to perform screening and follow-up testing. With adequate supervision, technicians, paramedics and emergency medical personnel, volunteers, nurses (as well as nurse aides and assistants), lab technicians, and respiratory therapists can be trained to perform some of these tasks on an as-needed basis.

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