[A qualitative study for identifying determinants of the quality of stroke patient referral]

Referral of patients from acute to rehabilitation care is a key stage in the overall quality of stroke care. The aim is to choose the most appropriate care pathway taking into account patient needs and preferences, as well as constraints such as bed availability. The objective of the project was to identify factors contributing to the quality of transfer decisions.

Semi-directive interviews were conducted among health care professionals, patients and their relatives. From this work, a preliminary list of factors contributing to the quality of the referral decision was issued. In order to identify their pertinence and feasibility, these factors were re-phrased into criteria, and introduced into a Delphi questionnaire which was circulated twice among a panel of 39 health care professionals.

At the end of the Delphi survey there was consensus about: the importance of the mutual knowledge between acute and rehabilitation teams, the possibility to call on rehabilitation competencies in order to define rehabilitation objectives while the patient is hospitalised in acute care, the attention given to patient preferences, and reliability of information exchange between teams. A consensus was reached for one of the six criteria regarding feasibility, specifically the awareness of admission procedures in rehabilitation wards.

Establishing a list of selected criteria is a first step in the development of an evaluation tools which could be used within a network of health care structures involved in the care of stroke patients.