WAITING LISTS FOR CORONARY-ARTERY SURGERY - CAN THEY BE BETTER ORGANIZED

Aim. To determine whether a numerical ranking system can provide an eq uitable basis for prioritising patients awaiting coronary artery bypas s grafting. Methods. A review of the current coronary surgery waiting list was undertaken using a newly developed scoring system. The factor s included in the score were age, symptoms, results of exercise testin g, coronary anatomy, employment status and perceived surgical risk. Th is score was compared with a Canadian consensus system. Rankings were then compared with the clinical priorities given by clinicians when th e patients were placed on the waiting-list. Results. There was excelle nt correlation between the two priority ranking systems using only tho se items included in the Canadian system (r = 0.9179). However, correl ation between the Canadian system and the full Green Lane Hospital (GL H) scoring system was weaker (r = 0.6869). The Canadian system assigne d higher surgical priorities than Auckland clinicians. Comparison betw een the GLH system and clinical priority gradings (O, urgent out of ho spital), (A) and (B) showed considerable scatter. Waiting times for th ese three categories considered acceptable by the Canadian consensus g roup were two to six weeks for priority (0), six weeks to three months for priority (A) and three to six months for priority (B). The mean t imes on the waiting list for the 260 patients still awaiting surgery a t GLH were two months for (O), 11 months for (A) and 22 months for (B) . Conclusions. The Canadian and expanded GLH ranking systems are no mo re than aids to establishing priorities. They cannot replace clinical judgement because the importance of individual scoring items is heavil y influenced by the ranking of other items. Waiting times for surgery are now grossly excessive despite the use of criteria for entry to the waiting list which are very conservative by international standards. There is no equitable or clinically acceptable way to modify prioritie s to reduce waiting times, and institution of a booking system is impr actical.