A comprehensive set of coded chief complaints for the emergency department

Acad Emerg Med. 2001 Oct;8(10):980-9. doi: 10.1111/j.1553-2712.2001.tb01098.x.


Objective: To develop a generally applicable set of coded chief complaints for the computerized patient records of emergency departments (EDs).

Methods: At an urban teaching ED the chief complaints of more than 50,000 patients were analyzed retrospectively during a 29-month period (June 1995-October 1997). Applying continuous quality improvement methods, a multidisciplinary team examined the current process documenting the patient's chief complaint. During two prospective periods (November 1997-December 1998; January 1999-June 1999), more than 34,000 chief complaints were analyzed. To reduce free-text charting practices, a variety of interventions on individual and team level were applied. Quantitative analysis was performed with statistical process control charts, and a qualitative evaluation was performed with a questionnaire.

Results: The charting of chief complaint in free-text format decreased from 23% to 1%. The range among individual ED staff members narrowed from 45% to 9%. During the refinement of the set of coded chief complaints, six infrequently charted items were removed. Five new chief complaints identified by analysis of free-text entries during the second study period were added. The current set of chief complaints consists of 54 codable and the three original free-text items. The ED staff members perceived all the interventions beneficial. A poster displaying all available terms as a visual aid, however, had the largest impact on charting the patient's chief complaint in coded format.

Conclusions: Applying continuous quality improvement methods, the authors created a clinically developed and applicable set of codable chief complaints that can be easily integrated into a computerized patient record of an ED.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Emergency Service, Hospital / organization & administration*
  • Emergency Service, Hospital / statistics & numerical data*
  • Follow-Up Studies
  • Forms and Records Control / organization & administration
  • Forms and Records Control / statistics & numerical data
  • Hospital Information Systems / organization & administration
  • Hospital Information Systems / statistics & numerical data
  • Humans
  • Medical Records Systems, Computerized / organization & administration
  • Medical Records Systems, Computerized / statistics & numerical data
  • Patient Satisfaction
  • Public Opinion
  • Quality of Health Care / organization & administration
  • Quality of Health Care / statistics & numerical data
  • Retrospective Studies
  • Surveys and Questionnaires
  • Time Factors