Who gets priority? Waiting list assessment using a scoring system

This study examines the relationship between clinical priority and duration on the waiting list. Patients' priority is also compared from three different perspectives: the consultant at out-patients (clinical urgency), the general practitioner who later sends a letter requesting expedition of admission (clinical urgency) and the 18-month waiters. Clinical priority in 222 patients awaiting primary hip or knee arthroplasty was assessed using a modification of the New Zealand priority criteria scoring system, administered by postal questionnaire. There was no correlation between time on waiting list and clinical score (r = 0.0). The hip and knee patient scores were not significantly different. The mean scores in the consultant and GP groups were higher (greater pain and disability) than in the 18-month waiters. The Kappa inter-rater agreement method demonstrated that both groups of clinician's assessment of clinical urgency had a 'fair' strength of agreement with scoring system, but the agreement of the 18-month waiter group was 'very poor'. Time on a waiting list should not be a decisive factor in establishing priority for primary hip or knee arthroplasty. Scoring systems can aid in assigning clinical priority for operation and indeed for the initial out-patient referral.