School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
Community and Oral Health Directorate, Metro North Hospital and Health Service, Herston,Australia.
Disabil Rehabil. 2022 Aug;44(17):4717-4728. doi: 10.1080/09638288.2021.1918770. Epub 2021 May 11.
To explore the decision-making processes and experiences of acute and rehabilitation clinicians, regarding referral and acceptance of patients to rehabilitation after stroke.
Multi-site rapid ethnography, involving observation of multidisciplinary case conferences, interviews with acute stroke and rehabilitation clinicians, and review of key documents within five (5) acute stroke units (ASUs) in Queensland, Australia. A cyclical, inductive content analysis was performed.
Seven key themes were identified, revealing the complex nature of post-stroke rehabilitation referral and acceptance decision making. Although the majority of clinicians felt that all patients could benefit from rehabilitation, they acknowledged this could not always be the case. Rehabilitation potential and goals were considered by clinicians, but decision making was impacted by ASU context and team processes, rehabilitation service availability and access procedures, and the relationships between the acute and rehabilitation clinicians. Patients and families were not actively involved in the decision-making processes.
Post-stroke rehabilitation decision making in Queensland, Australia involves complex processes and compromise. Decisions are not based solely on patients' rehabilitation needs, and patients and families are not actively involved in the decision-making process. Mechanisms are required to streamline access procedures, and improve shared decision making with patients.IMPLICATIONS FOR REHABILITATIONReferral decision making for post-stroke rehabilitation is complex and not always based solely on patients' needs.Clear and straightforward access procedures and positive relationships between acute and rehabilitation clinicians have a positive impact on referral decision making.Stroke services should review their processes to ensure shared decision making is facilitated when patients require access to rehabilitation.
探索急性和康复临床医生在将脑卒中患者转介和接受康复治疗方面的决策过程和经验。
多地点快速人种学研究，包括观察多学科病例会议、对急性脑卒中及康复临床医生进行访谈，以及对澳大利亚昆士兰州五个（5）急性脑卒中单元（ASU）的关键文件进行审查。采用循环式、归纳性内容分析法。
确定了七个关键主题，揭示了脑卒中后康复转介和接受决策的复杂性质。尽管大多数临床医生认为所有患者都可以从康复中受益，但他们承认并非所有情况都如此。临床医生会考虑康复潜力和目标，但决策受到 ASU 背景和团队流程、康复服务的可用性和准入程序以及急性和康复临床医生之间关系的影响。患者和家属并未积极参与决策过程。
澳大利亚昆士兰州脑卒中后康复决策涉及复杂的过程和妥协。决策并非仅基于患者的康复需求，且患者和家属并未积极参与决策过程。需要简化准入程序并改善与患者的共同决策机制。
脑卒中后康复转介决策复杂，并非仅基于患者的需求。明确和直接的准入程序以及急性和康复临床医生之间的良好关系，对转介决策具有积极影响。脑卒中服务机构应审查其流程，以确保在患者需要接受康复治疗时促进共同决策。
