Developing priority criteria for general surgery: results from the Western Canada Waiting List Project

Mark C. Taylor; David C. Hadorn; the Steering Committee of the Western Canada Waiting List Project

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Table 1

Summary of the Criteria and Score Development for the Western Canada Waiting List Project’s General Surgery Priority Form

Original tool Oct. 17, 1999		Pilot testing analysis, adjusted R² = 64.1%^*			Tool refinement June 2000

Criteria, items/levels		No.	%	Score	Weight		Criteria, items/levels
1.	Usual intensity of pain	560	100			2.	How bad is the pain at its worst?

	None	139	25	0	0		No pain

	Mild	163	29	0	3		Mild

	Moderately intense	162	29	10	7		Moderate

	Very intense	80	14	12	11		Severe

	Extremely intense	16	3	12

2.	Usual intensity of other forms of suffering	546	100			3.	Usual intensity of other forms of suffering

	None	174	32	0	0		None

	Mild	129	24	4	4		Mild

	Moderately intense	177	32	7	8		Moderate

	Very intense	55	10	10	12		Severe

	Extremely intense	11	2	15

3.	Usual frequency of painful episodes/suffering	561	100			1.	Usual frequency of painful episodes/suffering

	No pain	148	26	0	0		None

	Infrequent episodes of pain	240	43	0	3		Occasional

	In pain about half the time	118	21	0

	Only short episodes pain-free	42	8	3	6		Often

	Constant, never pain-free	13	2	7	9		Constant

4.	Usual degree of impairment in role function	559	100			4.	Degree of impairment in usual activities due to surgical condition

	Not impaired at all	175	31	0	0		Not impaired at all/mildly impaired

	Mildly impaired	236	42	0

	Able but difficult and/or somewhat impaired	99	18	9	5		Able but difficult and/or somewhat impaired

	Able but very difficult and at much reduced level	47	9	16	10		Able but very difficult and at much reduced level

	Totally dependent (unable to perform any role function)	2	0	16	15		Totally dependent (unable to perform any usual activities)

5.	Usual degree of impairment in social activities	560	100		Items 4 and 5 were combined

	Not impaired at all	215	39	0

	Mildly impaired	224	40	0

	Able but difficult and/or somewhat impaired	83	15	2

	Able but very difficult and at much reduced level	36	6	2

	Unable to perform any social activity	2	0	2

6.	History of major complications of the condition	557	100			5.	Recent history of major complications or additional significant physical examination or test results

	No	461	83	0	0		No

	Yes, but not recently	51	9	4	8		Yes

	Yes, recently	45	8	4

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Table 2

Correlation Matrix for the General Surgery Criteria Using Pilot Testing Data From 238 Patients

Item no.^*	9 VAS^†	Item no.
Item no.^*	9 VAS^†	1	2	3	4	5	6	7
1	0.02	1.00
2	0.41	0.25	1.00
3	0.12	0.69	0.35	1.00
4	0.25	0.62	0.42	0.68	1.00
5	0.25	0.49	0.42	0.58	0.79	1.00
6	0.20	0.13	0.14	0.14	0.28	0.27	1.00
7	0.65	−0.05	0.31	0.05	0.15	0.24	0.25	1.00
8	0.37	−0.08	0.04	−0.14	−0.06	−0.06	0.15	0.27

↵* Visual analogue urgency scale
Item description: 1 = usual intensity of pain, 2 = usual intensity of other forms of suffering, 3 = usual frequency of painful episodes/suffering, 4 = usual degree of impairment in role function, 5 = usual degree of impairment in social activities, 6 = history of major complications of condition, 7 = life-expectancy implications of condition without procedure, 8 = expected degree of improvement in life expectancy with surgery.

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Table 3

Interrater and Test–Retest Reliability of the Revised General Surgery Priority Criteria by 10 Surgeons

Item	Interrater reliability, ICC^*	Test–retest reliability, ICC^†
1. Usual frequency of painful episodes/suffering	0.67	0.77
2. How intense is the pain at its worst	0.82	0.83
3. Usual intensity of other forms of suffering	0.70	n/c
4. Degree of impairment in usual activities due to surgical condition	0.77	0.74
5. Recent history of major complications or significant examination/test results	0.34 (κ)	0.33 (κ)
6. Life expectancy implications of the condition without the procedure	0.86	0.89
7. Expected improvement in life expectancy with surgery	0.56	0.67
8. Visual analogue scale urgency	0.83	0.92

↵* Data collected in January 2001
↵† Test–retest interval was approximately 2 mo.
‡ Intraclass correlation coefficient. Higher value indicates greater agreement.
ICC = intraclass correlation coefficient, n/c = not computed since the item was not identical in the test and retest versions.