Article

Less than half of the patients with stroke in Australian hospitals are
assessed by rehabilitation specialists. We sought to explore how clinicians
working in acute stroke units (ASUs) determine which patients to refer to
rehabilitation services.
METHOD: Qualitative descriptive study. Team meetings
were observed and medical records were reviewed over four weeks at two ASUs.
Focus groups were conducted with staff from eight ASUs in two states of Australia. RESULTS: Rehabilitation was mentioned in team meetings for 50/64
patients (78%) during the observation period. Rehabilitation referrals were
organised for 47 patients (94%) for whom rehabilitation was discussed (74% of the
sample); and for no patients when rehabilitation was not discussed. Factors
identified that influenced whether referrals were organised included the
anticipated discharge destination; severity of stroke; staff expectations of the
patient's recovery; and if there was advocacy by families about rehabilitation.
Clinicians tended to refer the patients they considered would be accepted by the
rehabilitation service. Staff at two ASUs expressed concern that referring all
patients with stroke-related deficits to rehabilitation would be unfavourable
with rehabilitation providers. CONCLUSIONS: Decisions made by ASU staff regarding
who to refer to stroke rehabilitation are often not solely based on patients'
rehabilitation requirements. Implications for Rehabilitation Not all patients on
acute stroke units (ASUs) who may have benefited from rehabilitation were offered
rehabilitation referrals. Criteria for rehabilitation referrals need to be made
explicit and discussed openly with consumers, ASU clinicians and rehabilitation
specialists. A change in rehabilitation assessment practices is required to
provide data regarding the unmet rehabilitation needs of patients with stroke.
New models of rehabilitation service delivery or increased rehabilitation
services may be required to meet the rehabilitation needs of all patients with stroke.

Langue : ANGLAIS