Developing priority criteria for general surgery: results from the Western Canada Waiting List Project.

Abstract

OBJECTIVE: The Western Canada Waiting List Project (WCWL) is a federally funded partnership of 19 organizations, including medical associations, health authorities, ministries of health and research organizations that was created to develop tools for improving the management of waiting lists. The WCWL general surgery panel was 1 of 5 panels constituted under this project. METHOD: The panel developed and tested a set of standardized clinical criteria for setting priorities among patients awaiting elective general surgery of all kinds. The criteria were applied to 561 patients in 3 western provinces. Regression analysis was used to determine the set of criteria weights that collectively best predicted clinicians' overall urgency ratings. RESULTS: The priority criteria accounted for almost two-thirds of the observed variance in clinicians' urgency ratings (adjusted R2 = 64.1%) for a mixed group of patients. The panel modified the criteria and weights based on empiric findings and clinical judgment. Interrater and test-retest reliability of criteria items appeared to be good, based on clinicians' ratings of 6 videotaped, standardized patient interviews. CONCLUSIONS: The panel considered the criteria easy to use and reasonably reflective of expert surgical judgement regarding clinical urgency. Further development and testing of the tool appears warranted.