Prioritizing patients for elective surgery: clinical judgement summarized by a Linear Analogue Scale.
BACKGROUND
The New Zealand health reforms have resulted in the requirement that surgeons utilize Clinical Priority Access Criteria (CPAC) to ration patient access to elective surgery. The validity of the tools used as CPAC has been challenged. An alter-native tool, the Linear Analogue Scale (LAS), is therefore used in our institution. Our objectives were to determine the variables that influence the priority score generated using the LAS, and the length of time waited by patients awaiting general surgical procedures.


METHODS
A cohort of 918 patients who were listed for elective general surgical procedures at Auckland Hospital, Auckland, New Zealand between 1 July 1998 and 31 March 1999 were studied. Patients were given a priority score generated using the LAS. For each patient, the time from assessment until his or her procedure was documented. Linear and logistic regression models were used to investigate variables (age, gender, diagnosis and surgical team) that influence priority score. Cox proportional hazards models were used to investigate variables (priority score, age, gender, and diagnosis) that influence the length of time waited.


RESULTS
Graphical presentation showed a pattern of priority scores falling into 'bands' for different diagnoses. Diagnosis, and to a lesser extent surgical team, influenced priority score. Survival analysis showed 'time waited' to be influenced by priority score, diagnosis, and patient age and gender.


CONCLUSIONS
The LAS may have a useful role in the difficult sphere of patient prioritization. Its strength lies in its simplicity. Further investigation of reliability and effect on patient outcomes is required.
MacCormick
Andrew D
AD
Division of Surgery, School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, New Zealand. andrew.maccormick@auckland.ac.nz
Plank
Lindsay D
LD
Robinson
Elizabeth M
EM
Parry
Bryan R
BR
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures; D005260:Female; D015276:Health Care Rationing / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D018579:Patient Selection; D017064:Process Assessment, Health Care / Q000379:methods*; D016016:Proportional Hazards Models; D014218:Triage / Q000379:methods*; D014850:Waiting Lists