Table 2.
Barriers to effective SCP implementation identified by healthcare professionals
| 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 |
SAMU: Service d’Aide Médicale Urgente (coordination of pre-hospital EMS);
EMS: Emergency Medical Services.
Origin of the verbatims
1GP; 2EMS specialist; 3Neurologist; 4Neurologist and PRM physician; 5Neurologist; 6Heads of PRM structures; 7SAMU coordinator; 8Senior resident working in emergency department; 9Head of Neurovascular Unit; 10Neurologists; 11GP and emergency department physician; 12Nurse and social worker; 13GP and neurologist; 14SAMU coordinator, GP and neurologist; 15GP in mountain area; 16GPs and EMS specialists.