a quick and dirty ROS

[realruby2000]

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ok mabey not dirty, but I was wondering if anyone had a good method of doing a quick and complete ROS that would be applicable in the ER... i heard overheard a 4th year do one a while back in the ERand it was pretty damn good...but i can't remember it all.... what do most of you say in your ROS?

 

[USAF MD '05]

Fever, chills, n/v/d? HA, SOA, CP, numbness, tingling, dizziness, vision probs.
I basically just check constitutional sx, plus some basic neuro ones. Also make sure to tailor what you ask to what is relevant with the cheif complaint. If someone comes in with a HA and God forbid you actually touch on their chronic constipation ar low back/knee/elbow pain you are in trouble. You can get easily sidetracked and miss the whole purpose of the visit. I always tell my patients they are only allowed one complaint at a time. (Unless of course they have 2 or more truly emergent things going on, which is rare.)
Steve

 

[NinerNiner999]

Ok - I'll bite. Head to toe in one minute or less:

Any thinning of the hair, hot/cold intolerance, fevers/chills/night sweats, problems with vision, hearing, swallowing. Sinus trouble? sore throat? Problems moving your arms, elbows, hands? shortness of breath, cough, congestion? Do you feel your heart beating differently? Faster, slower, louder? Chest pain? How are you eating? any belly pain, tenderness, nausea, vomiting, diarrhea, conspitation? Normal colored stools? what color? Urinating ok? Any pain or burning when you urinate, any foul smell to the urine? Pain in your thighs, knees, shins, ankles, or toes? Any problems with gait, weakness, numbness, or tingling? How would you describe your mood?

For billing purposes - this covers every individual system and leaves plenty of time for focused H&P. Just what I like to use...

 

[drewpydog]

As far as billing purposes, all you have to say in your dictation for review of systems is "as in history of present illness, all other systems are reviewed and are negative." You get paid as if you did a complete >10 system review. So in your HPI, just say the ususal crap that goes along with the CC and you are done.

 

[NinerNiner999]

Yeah, and I can check the box on the T-sheet too. JHH uses our own template that requires us to circle each system reviewed (that is their equivalent of the "All other systems negative unless marked" box). I like the T system at our other hospitals better, but I guess I've just gotten used to the questioning...

 

[The White Coat Investor]

I find it easier to ask a couple of extra questions to get a "complete" ROS so I can save time on the dictation by saying: "All other systems reviewed and are negative except as mentioned in the HPI." Remember, for billing purposes, one question in each system is considered a review of systems. One person I knows dictates: No fever, rash, headache, dysphagia, visual changes, neck pain, chest pain, dyspnea, abdominal pain, dysuria, bleeding problems, weakness, diabetes, or psychiatric problems. Doesn't take long to dictate, and fully billable. The ROS isn' t about medicine anyway, its about billing. All the really important info for medical purposes is in the HPI.