Chief Complaints

The concept of a chief complaint is important in medicine. It is a statement of the reason that a patient seeks medical care. Medical and nursing schools teach future clinicians to begin their verbal presentations of patient cases with a statement of the chief complaint. They teach them to record the chief complaint using the patient's words and to avoid replacing the patient's words with their diagnostic interpretation. It is considered bad form to proffer a diagnostic impression in a chief complaint.1

1 The reasons for this practice are myriad. One reason is that other clinicians such as consultants and supervisory clinicians in academic medical centers read a patient's chart like detectives: They wish to form an independent diagnostic impression. They are interested in knowing 'just the facts.'

Handbook of Biosurveillance ISBN 0-12-369378-0

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figure 23.1 Points in the healthcare process at which chief complaints and ICD codes are recorded and transmitted to a health department or other biosurveillance organization. This figure illustrates a hypothetical patient with anthrax who seeks care at an emergency department (ED) and is subsequently admitted to a hospital. The patient's chief complaint is recorded at the time of registration and transmitted immediately to a health department via a HL7 message router. When the patient is discharged from the ED and admitted to the hospital, a professional coder reads the patient's ED chart and assigns ICD codes for billing purposes.The delay in transmission to a health department is indicated by a slanted arrow.Another ICD code may be assigned at the time of hospital admission. Finally, ICD codes are assigned by professional coders at the time of hospital discharge. These codes are transmitted to third party payers, who may submit them to data aggregators (e.g., commercial companies that analyze healthcare trends or health departments that assemble hospital discharge data sets for statistical purposes). In general, the diagnostic precision of the data available to a health department increases over time (moving from left to right in the figure). Note that there is variability from healthcare system to healthcare system. In some settings, the chief complaints are coded directly into ICD codes by physicians at the time of service (e.g., U.S. military).

figure 23.1 Points in the healthcare process at which chief complaints and ICD codes are recorded and transmitted to a health department or other biosurveillance organization. This figure illustrates a hypothetical patient with anthrax who seeks care at an emergency department (ED) and is subsequently admitted to a hospital. The patient's chief complaint is recorded at the time of registration and transmitted immediately to a health department via a HL7 message router. When the patient is discharged from the ED and admitted to the hospital, a professional coder reads the patient's ED chart and assigns ICD codes for billing purposes.The delay in transmission to a health department is indicated by a slanted arrow.Another ICD code may be assigned at the time of hospital admission. Finally, ICD codes are assigned by professional coders at the time of hospital discharge. These codes are transmitted to third party payers, who may submit them to data aggregators (e.g., commercial companies that analyze healthcare trends or health departments that assemble hospital discharge data sets for statistical purposes). In general, the diagnostic precision of the data available to a health department increases over time (moving from left to right in the figure). Note that there is variability from healthcare system to healthcare system. In some settings, the chief complaints are coded directly into ICD codes by physicians at the time of service (e.g., U.S. military).

As a result, the chief complaint usually states the key symptoms that a patient is experiencing.

During the process of medical care, a patient's chief complaint is recorded many times. Triage nurses and registration clerks create the first record at the time of initial registration for service at a clinic or emergency department (ED). Clinicians also record chief complaints in daily progress notes and discharge, transfer, and patient acceptance summary notes.

The research that we will discuss has shown that chief complaints contain information that may be very useful in biosurveillance. This result is not surprising. If a patient is ill with an infectious disease and presents to a physician, we would expect her chief complaint to reflect the nature of the illness.

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