Table 2 Barriers to effective SCP implementation identified by healthcare professionals
From: Main barriers to effective implementation of stroke care pathways in France: a qualitative study
Barrier typology | Interviewees n/44 (%) | Illustrative examples of verbatims |
|---|---|---|
Coordination within network: data availability and sharing passing on information staff communication | 14 (32) | Waiting times too long when calling the SAMU1 |
Fire brigade and triage nurses not familiar with stroke symptoms2 | ||
Residents not trained to recognise stroke symptoms3 | ||
Hospital reports not transmitted to downstream facilities in good time4 | ||
Coordination between facilities | 27 (61) | Disagreements between EMS and neurologists about patient care 5 |
Hospital physicians unaware of downstream facilities admitting stroke patients6 | ||
Inappropriate requests for admission to rehabilitation centres6 | ||
What the fire brigade decides is not what the SAMU recommends7 | ||
Patients taken to hospital emergency department by the SAMU without prior notification8 | ||
Administrative procedures for transferring patients to downstream structures too long9 | ||
Professional and organisational practices | 16 (36) | No established hospital protocol for stroke management10 |
Patients refused by stroke units in order to keep beds available for patients who are eligible for thrombolysis11 | ||
Patients not admitted to rehabilitation centres for financial reasons12 | ||
Public education | 13 (29) | No or little knowledge of stroke symptoms, disease seriousness or treatments13 |
No knowledge of pre-hospital EMS or how to call them14 | ||
Logistic resources | 31 (70) | No ambulances or helicopters for patient transport15 |
No beds available in stroke units16 |