International survey of perceived barriers to admission and discharge from spinal cord injury rehabilitation units

Study design: Survey. Objectives: To describe and compare perceived barriers with patient flow in spinal rehabilitation units (SRUs). Setting: International. Ten SRUs (Australia, Canada, India, Ireland, Italy, Netherlands, Pakistan, Switzerland, UK and USA) that admit both traumatic and non-traumatic spinal cord injury patients. Methods: Survey completed between December 2010 and February 2013 on perception of barriers for admission into and discharge from SRUs. Opinion was sought from the participants regarding the utility of collecting data on the timeliness of access to SRUs and occurrence of discharge barriers for benchmarking and quality improvement purposes. Results: The perceived barriers in accessing SRUs ranged from no access problem to a severe access problem (no access problems n = 3; minor access problems n = 3; moderate access problems n = 2; severe access problem n = 1 and extreme n = 1). Most units (n = 9/10) agreed that collecting data on timeliness of access to SRUs for acute hospital patients may help improve patient outcomes and health system processes by providing information for benchmarking and quality improvement purposes. All units reported perceived barriers to discharge from SRUs. Compared with admission barriers, a greater perception of barriers to discharge was reported (minor problem n = 3; moderate problem n = 3; severe problem n = 3; and extreme n = 1). All units agreed that collecting data on barriers to discharge from SRU may help improve patient outcomes and system processes. Conclusions: Perceived barriers to patient flow in SRUs are reported in many countries. Projects to identify and minimise the occurrence and impact of admission and discharge barriers could increase access to rehabilitation and improve the rehabilitation outcomes for patients.