The Complex Care Review of Systems: An Aid to the Initial Evaluation of Severely Neurologically Impaired Children and Adolescents
David E Hall M.D.
Whenever a new complex, neurologically impaired patient is first encountered in the hospital or clinic, obtaining a complete history and creating a problem list can be overwhelming. Even if one has the time to obtain the history chronologically, families may leave out important details.
We have successfully used the following adaptation of a review of systems (Table 1) during the initial encounter in our Program for Children with Medically Complex Needs at Vanderbilt. This review of systems, when combined with initial open-ended questions about the family’s concerns, will capture the most important elements needed to create a summary of the patient’s problems. The review of systems can easily be added as a template in the computerized medical record. In the Epic medical system, for example, it can be incorporated into a dot phrase.
Each section in the review of systems can be expanded or condensed as needed. For example, one may or may not want to list things such as tracheostomy size or ventilator settings, depending on the provider’s level of management of the problems in this area.