Experience of Transfers to Rehabilitation Services

This is an observational project that will utilise a mixed methods approach, where demographic, clinical and questionnaire data will be synthesised with content analysis of semi-structured interviews to provide a well-rounded understanding of patient and whanau experiences of transitions of care to and from inpatient rehabilitation, and stroke care in general, before and after the opening of Ward 51 (the upcoming Integrated Stroke and Adult Rehabilitation Unit) at ADHB. Phase 1 occurs within the existing structure and processes for ADHB Rehabilitation Services. Under this structure patients will have acute hospital care, then be transferred into Rehabilitation Services. Patients who are eligible for participation will be invited to take part in this study, and will complete their participation before Phase 2 begins. Phase 2 will occur after the opening of Ward 51, the new Integrated Stroke and Rehabilitation Unit. Under this structure, patients with stroke will enter Ward 51 on arrival to hospital, receive their hyperacute, acute and rehabilitation care in the unit, and will then discharge home with community rehabilitation services in place. Participants recruited during this phase will experience a different care transition process than participants recruited during Phase 1. There are two groups of patients and whanau who will be potentially eligible for participation, defined below. Group 1: Stroke patients who transfer from the ADHB acute stroke service to ADHB inpatient rehabilitation, and their whanau. Group 2: Non-stroke patients who transfer from any other ward or hospital to ADHB inpatient rehabilitation. The main comparison of interest is between Group 1 patients recruited in Phase 1 and Phase 2. The primary outcome is the change inpatient experience for stroke patients who transfer to ADHB inpatient rehabilitation from ADHB acute stroke services. This will involve a transfer to Rangitoto ward during Phase 1, and will occur within Ward 51 during Phase 2. Patients and whanau who consent to participation will be asked to complete brief surveys around 1 week after beginning inpatient rehabilitation. This will take up to 30 minutes. They will also be invited to discuss their experiences of transitioning to rehabilitation with a member of the research team. This discussion can take only a few minutes or as long as the participant wants. This discussion will be audio recorded and participants will be provided with a transcription of the discussion which they can revise or correct before it is included in the analysis. Patients will also be asked to complete brief surveys around 2 weeks after leaving the hospital. They can choose to do this over the phone or in person at a location of their choice. If they choose to return to hospital their transport will be provided at no cost to them. Clinicians involved in inpatient stroke care will be emailed a link to an anonymous online survey regarding their perceptions of coordination of care. They will consent by choosing to complete the survey, which is expected to take around 5 minutes. Clinicians will be invited to complete this survey once before Ward 51 opens, and once more after it opens, with no linkage between data collected at these two time points.