What is the process for performing a systems review?

How to Perform a Systems Review

A comprehensive systems review should include structured assessment of cognition, daily function, mood and behavior, and sensorimotor function, using validated tools whenever feasible and incorporating both patient and reliable collateral information. 1

Core Components of Systems Review

1. General Assessment

• Vital signs: blood pressure, temperature, pulse rate, respiratory rate 2
• Consider adding pulse oximetry as it has been shown to change patient care and outcomes 2
• Document height and weight 1
• Assess for unexplained weight loss, night sweats, fever, changes in body habitus 1

2. System-Specific Assessment

Skin

• Assess for skin discoloration, rash, ulcers, lesions 1
• Look for specific conditions: seborrheic dermatitis, ecchymoses, purpura, petechiae, psoriasis, fungal infections 1

Lymphatic

• Check for localized or generalized lymph node enlargement 1

HEENT (Head, Eyes, Ears, Nose, Throat)

• Eyes: vision changes or loss, retinal abnormalities 1
• Mouth/Oropharynx: gum disease, ulcers, oral lesions, pain 1

Cardiovascular

• Assess for chest pain, palpitations, heart exam, peripheral pulses 1
• Document presence/absence of edema 1

Respiratory

• Evaluate for shortness of breath, wheezing, dyspnea, orthopnea 1
• Perform lung examination 1

Gastrointestinal

• Document diarrhea, nausea, pain 1
• Assess for hepatomegaly, splenomegaly, masses, tenderness 1

Endocrine

• Check for symptoms of hyperglycemia, thyroid disease, hypogonadism 1

Neurological and Psychiatric

• Evaluate for headaches, memory loss, concentration issues, depression, anxiety 1
• Assess for paresthesias, pain, numbness, paralysis, weakness, cognitive difficulties 1

Genitourinary

• Document dysuria, discharge, lesions, hematuria 1

Musculoskeletal

• Assess for hip pain, joint pain, fractures 1
• Evaluate risk factors for osteopenia/osteoporosis 1

Frequency of Systems Review Updates

• For stable patients: Update at least every 6 months 3
• For high-risk or unstable patients: Update every 3-6 months 3
• For patients with high/moderate disease activity: Consider monthly updates 3
• Tailored frequency based on patient's risk stratification:
  • First 2 years: Every 3-6 months
  • Years 3-5: At least every 6 months
  • Beyond 5 years: At least annually 3

Best Practices for Systems Review

Documentation Approach

1. Use structured templates or checklists to ensure comprehensive assessment
2. Document both positive and negative findings
3. Compare with previous systems reviews to identify changes
4. Include both subjective (patient-reported) and objective (clinician-observed) findings

Implementation Strategies

• Consider implementing automated audit and feedback systems to ensure compliance with update schedules 3
• Use validated assessment tools when available
• Include depression, posttraumatic stress disorder, and domestic violence screening as part of the initial evaluation and at periodic intervals 1

Clinical Value of Regular Systems Review

Regular systems review updates contribute to improved patient outcomes through:

• Early detection of disease progression or complications
• Identification of medication side effects
• Enhanced patient engagement in their care
• Improved continuity of care across healthcare settings 3

Common Pitfalls to Avoid

1. Incomplete assessment: Failing to cover all body systems
2. Relying solely on patient self-report: Collateral information from reliable informants is often necessary 1
3. Inconsistent documentation: Using different formats or terminology between visits makes tracking changes difficult
4. Overlooking subtle changes: Small changes in symptoms may indicate significant clinical developments
5. Routine performance without clinical reasoning: Systems review should not be performed mechanically but with clinical judgment

By following this structured approach to systems review, clinicians can ensure comprehensive assessment, early detection of changes in patient status, and improved clinical outcomes.