Meyer Matthew J, Teasell Robert, Kelloway Linda, Meyer Samantha B, Willems Deborah, O'Callaghan Christina
a Lawson Health Research Institute, Parkwood Institute , London , ON , Canada.
b London Health Sciences Centre , London , ON , Canada.
Disabil Rehabil. 2018 Dec;40(26):3120-3126. doi: 10.1080/09638288.2017.1377296. Epub 2017 Sep 18.
Stroke units have been established as best practice care, in part because they offer timely initiation of rehabilitation. Experts in Ontario, Canada recommend that eligible patients be transferred to inpatient rehabilitation (on average) by day 5 after ischemic stroke and day 7 after a hemorrhagic stroke. This study explores perceived barriers to implementation of these recommendations and potential solutions.
Exploratory focus groups were held with stakeholders from five geographically diverse regions across Ontario between September 2011 and January 2012. Participants were asked to consider the recommendations, list perceived barriers and to collectively discuss potential solutions. Data analysis included coding of transcribed data, sorting material to identify themes and confronting themes with a formalized body of knowledge.
Barriers identified by participants fell into three categories: patient-centered, clinician-focused and resource or system based, within these, specific challenges included managing patients' medical and emotional readiness for rehabilitation, timely completion of medical tests, staff comfort in discharging patients, dedicated transportation and funding-related concerns.
The structure of Ontario's health care system presents challenges to early transfer of stroke patients to inpatient rehabilitation, yet the stakeholders consulted in this study felt that these could be addressed with proper planning, improved coordination and targeted investment. Implications for rehabilitation Stroke units are a well-established best practice in stroke care and timely access to rehabilitation is a key component of their effectiveness. Stroke experts in Ontario, Canada recommend transfer of suitable patients to inpatient rehabilitation on day 5 and day 7, on average, after ischemic and hemorrhagic stroke, respectively. Stakeholders report that meeting these targets may require some adjustments to local processes of care, many of which can be achieved with little to no financial investment.
卒中单元已被确立为最佳实践护理模式，部分原因是它们能及时启动康复治疗。加拿大安大略省的专家建议，符合条件的患者在缺血性卒中后平均第5天、出血性卒中后平均第7天转入住院康复治疗。本研究探讨了实施这些建议过程中所察觉到的障碍以及潜在的解决办法。
2011年9月至2012年1月期间，与来自安大略省五个地理区域的利益相关者举行了探索性焦点小组会议。参与者被要求考虑这些建议，列出察觉到的障碍，并共同讨论潜在的解决办法。数据分析包括对转录数据进行编码、整理材料以识别主题，并用一套正式的知识体系来审视这些主题。
参与者识别出的障碍分为三类：以患者为中心、以临床医生为重点以及基于资源或系统的障碍。在这些类别中，具体挑战包括处理患者接受康复治疗的医疗和心理准备情况、及时完成医学检查、工作人员对患者出院的顾虑、专用交通以及与资金相关的问题。
安大略省医疗保健系统的结构给卒中患者早期转入住院康复治疗带来了挑战，但本研究中咨询的利益相关者认为，通过适当规划、改善协调和有针对性投资可以解决这些问题。对康复的启示 卒中单元是卒中护理中已确立的最佳实践模式，及时获得康复治疗是其有效性的关键组成部分。加拿大安大略省的卒中专家建议，分别在缺血性卒中和出血性卒中后平均第5天和第7天，将合适的患者转入住院康复治疗。利益相关者报告称，要实现这些目标可能需要对当地护理流程进行一些调整，其中许多调整几乎无需资金投入即可实现。
