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 differ ent perspectives: the consultant at out-patients (clinical urgency), the ge neral practitioner who later sends a letter requesting expedition of admiss ion (clinical urgency) and the 18-month waiters, Clinical priority in 222 p atients awaiting primary hip or knee arthroplasty was assessed using a modi fication 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 a nd disability) than in the 18-month waiters, The Kappa inter-rater agreemen t method demonstrated that both groups of clinician's assessment of clinica l urgency had a 'fair' strength of agreement with scoring system, but the a greement of the 18-month waiter group was 'very poor'. Time on a waiting li st should not be a decisive factor in establishing priority for primary hip or knee arthroplasty. Scoring systems can aid in assigning clinical priori ty for operation and indeed for the initial out-patient referral.