Focusing on a “Serious” Review of Systems in the Emergency Department

We compared serious and non-serious review of systems (ROS) complaints in the Emergency Department (ED). There were 173 adults discharged from an urban county ED who were administered a 56-item ROS identical to the ED chart ROS. Blinded review of ED charts determined which ROS complaints were documented by clinicians and whether ROS complaints were addressed by ED diagnostic testing or physical examination (PE). Mean differences in proportions with 95% confidence intervals (CIs) between serious and non-serious ROS complaints were: 1) For whether patients expected ROS complaints addressed in the ED, 15.7% (95% CI 6.5–24.2); 2) For ROS complaints concomitantly noted on ED charts by providers, 9.0% (95% CI 1.7–17.6); and 3) For whether provider-noted ROS complaints were addressed by testing or PE, 21.2% (95% CI 4.2–38.3). Discharged ED patients expect more of their serious ROS complaints to be addressed. More serious ROS complaints are noted and addressed by ED providers, but most ROS complaints noted by providers are not addressed.