Identification of criteria for the prioritisation of patients for elective general surgery.
OBJECTIVE
A single visual analogue scale is used in New Zealand to prioritise patients for elective general surgery. Although it reflects clinical judgement, it has been criticised for its lack of transparency. We wished to elicit generic criteria used by surgeons for prioritisation of patients for elective general surgery in order to improve the transparency of the visual analogue scale.


METHODS
Semi-structured interviews were undertaken with 15 general surgeons. Using the repertory grid method, surgeons were asked to explain their rationale for distinguishing between patients they considered a high, medium or low priority for treatment. Interviews were audiotaped, transcribed and analysed for themes. The accuracy of the thematic analysis was checked using a five-point Likert scale to assess surgeons' agreement with the identified themes. Further testing to check for face, content and construct validity was undertaken with a purposive sample of six surgeons prioritising patient vignettes.


RESULTS
Eight major themes were deduced: diagnosis; treatment; patient characteristics; symptomatology and sequelae to date; future complications; quality of life; psychological/emotional impact; and socio-political/logistic factors. The utilisation of these themes by surgeons was confirmed. Tests of collinearity indicated good content validity. Factor analysis confirmed the hypothesis of one underlying construct, namely priority.


CONCLUSIONS
Seven of the themes became the basis for a new clinical priority assessment criteria tool using visual analogue scales to determine priority of patients for elective general surgery. Further testing of reliability and validity is needed.
Divison of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1001, New Zealand.
Andrew
A
MacCormick
Alexandra
A
Macmillan
Bryan
B
Parry
D001291:Attitude of Health Personnel; D003661:Decision Support Techniques; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D013502:General Surgery; D015276:Health Care Rationing / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D009520:New Zealand; D010147:Pain Measurement; D018579:Patient Selection; D017064:Process Assessment, Health Care; D011788:Quality of Life; D012959:Socioeconomic Factors; D014218:Triage / Q000379:methods; D014850:Waiting Lists