Coordination Of Services Research Articles

Examining management plans for patients who frequently presented to the emergency department

BackgroundPatients who frequently present to Emergency Department (ED) experience complex health and social needs. While research has examined interventions that aim to decrease frequent ED attendances, there is a need to understand the types of interventions provided to patients by hospital clinicians during presentations. MethodsUsing qualitative content analysis, 82 management plans were evaluated to understand the scope and type of interventions provided by clinicians for patients frequently presenting to the ED at the Royal Melbourne Hospital, Australia. ResultsPatients often presented to the ED due to mental and psychological distress, substance use and physical health concerns alongside psychosocial vulnerabilities. The goals of care documented in plans focussed on management of health issues, aggression within the ED, and coordinating care with community services. Recommended interventions addressed presenting needs with multi-disciplinary approach to respond to distress and aggression. Finally, the plans provided insight into service coordination dynamics between the ED and community-based health and social care services. ConclusionsThe plans recommended interventions that sought to provide holistic care for patients in collaboration with relevant community-based services. The findings suggest that clinicians in the ED can provide appropriate and meaningful care for patients who experience frequent presentations.

Consultation analysis of dementia triads in Portuguese general prac-tice: exploratory study

Introduction: Despite policy recommendations worldwide, too often dementia remains outside the scope of primary health care. In the context of Portuguese primary health care services, our group previously explored the experiences of people with dementia, carers, general practitioners (GPs), and other professionals, together with their perspectives on barriers to dementia care. However, we know little about triadic consultations that involve a patient, their carer, and their GP. Objective: To explore dementia care in triadic consultations in general practice. Methods: Analysis of ten consultations with dementia triads across six Portuguese practices from different social contexts. Purposive sampling was used to recruit nine GPs, ten patients, and ten carers. Triadic consultations were digitally recorded, transcribed, and analysed. The analytical framework combined codes derived from the transcripts with codes from the available literature. Themes focused on the corollaries of dementia (e.g. need for information), and coordination of services. Results: Dementia-related content took up only 30% of consultations, despite their length (median 27 min). The GPs did not seem engaged in dementia management, their assessments lacked breadth and person-centredness, and interventions were limited. Carers facilitated GPs’ assessment of dementia consequences, but their needs were poorly assessed. Patients’ self-expression was limited by communication patterns within the triad. Conclusion: It is challenging for GPs to assess dementia among other conditions in a context of fragmented care. Strategies for improving family carers’ assessments are needed. The analysis of triadic consultations may provide potential process measures for assessing the quality of clinical practice and consultation training in general practice, but this requires further study.

Simulation-based optimization of timetables coordination in an urban rail transit network

Synchronous optimization of train timetables is to solve the problem of train service coordination among different lines in the urban rail transit network, which can reduce passenger waiting time and subsequently enhance passenger satisfaction. This paper develops an efficient simulation system to reproduce the train operation of an urban rail network. It takes into account the realistic characteristics of urban rail operations, including time-dependent demand, dynamic dwell time, and train capacity constraint. In the simulations, both the train trajectories and the passenger waiting time can be easily obtained. On this basis, a simulation-based algorithm (i.e., simultaneous perturbation stochastic approximation, SPSA) is designed to search an improved flexible-interval dispatch solution in the network. A case study of the Chengdu urban rail transit network is implemented to verify the effectiveness of the simulation system and the optimization algorithm. The simulation system is found to be time efficient since it takes less than 1 s to simulate the network with 4 h of operation and more than 200,000 passengers. The optimization algorithm is also effective as it can reduce the average passenger waiting time by 9.52 % compared to the equal-interval dispatch solution without increasing the train service frequency. It is also found that the reduction in waiting time is mainly due to the improved coordination of train services in the transfer station.

Cooperative online schedule of interconnected data center microgrids with shared energy storage

The rapid increasing of data centers calls for an efficient method to reduce high operation costs and carbon emissions. This paper proposes a cooperative online schedule framework for local interconnected data centers considering shared energy storage. A time-average optimization problem is built to reduce the overall operation cost with essential operational constraints. Multiple randomness and the temporal coupling constraints of energy system levels make it challenging to solve the stochastic problem. Adapting the Lyapunov optimization theory with relaxation and perturbation technique, an online algorithm is proposed to find an acceptable solution to the problem to achieve both good service coordination and efficient energy coordination. The algorithm does not require prediction of random parameters, and has a fast convergence rate. Especially, the theoretical conditions for convergence and the distance between the acceptable and real optimal solution are derived in a closed form. Simulation studies show that the algorithm can effectively reduce operation cost of data centers, carbon emissions, and dependence on the main grid.

Analysis of Drug Availability Management at the Regional General Hospital Pharmacy Installation

Pharmacy managerial activities are inseparable from the principles of drug availability management such as a series of needs planning activities, procurement, storage and distribution of drugs through hospital pharmacy installations. This study aims to analyze and obtain information on availability management at the Pharmacy Installation of the South Tapanuli Regional General Hospital. This type of research is qualitative with a descriptive approach using primary data and secondary data using the interview method. The informants interviewed at the pharmaceutical installation were the head of the pharmaceutical installation unit, the coordinator of pharmacy services, the head of the pharmaceutical warehouse/supplies, the coordinator of quality management and administration. Informants of this study were taken by purposive sampling and data analysis using triangulation and data reduction methods. The results of this study obtained that planning for drug needs uses the consumption method by looking at the need for previous use, but it has not been maximized, procurement has not gone well, drug shortages often occur, drug storage systems use the FIFO (First in First Out) and FEFO (First Expired First Out) systems. First Expired First Out). Storage is not up to standard, the waiting time for drug distribution to patients starting from the patient submitting the prescription to the delivery of the drug takes quite a long time for the drug to be finished. The conclusion is that the implementation of drug availability management has not run optimally according to standard operating procedures for services, so it is necessary to increase human resource knowledge through training related to drug planning.

Making Harm Reduction More Accessible: Fentanyl Test Strip Awareness and Attitudes among Emergency Department Patients Who Use Drugs

Background Fentanyl test strips (FTS) are a harm reduction method for people to test their drugs for fentanyl. Ideal points for FTS distribution have not been identified. Many people who use drugs have frequent contact with the Emergency Department (ED). We piloted FTS distribution in two urban hospital EDs. Methods Between June-December 2021 in Philadelphia, PA, patients with past 30-day drug use completed a survey about drug use, fentanyl attitudes, and FTS; then offered FTS and a brief training. Survey data were analyzed using SPSS for bivariate statistics. Results Patients (n = 135) were primarily White (68.1%) and male (72.6%). Participants regularly interacted with substance use (57.8%) and benefits coordination (49.6%) services. The most common drugs used were heroin/fentanyl (68.9%), crack cocaine (45.2%) and cannabis (40.0%). Most (98.5%) had heard of fentanyl though few (18.5%) had ever used FTS. Across most drug types, participants were concerned about fentanyl. All accepted FTS training and distribution. Few (9.6%) were somewhat or very concerned about having FTS if stopped by police and this number varied by race (7.6% of White people were somewhat or very concerned, compared to 12.8% of Black people). Most participants were already engaged in risk reduction practices. Discussion FTS are a widely desired harm reduction tool to facilitate informed decision-making, and non-harm reduction locations are potentially feasible and acceptable distribution sites. Given regular contact with EDs and social services across the sample, FTS should be offered at non-harm reduction locations that come into frequent contact with people who use drugs.

Clustering users of healthcare, social and employment services: a register study from Finland

Abstract Background Understanding the population's overall use of healthcare, social and employment services is important for comprehending service needs and improving the coordination of services. The aim of this exploratory study was to find separate groups in a working-age population based on individuals’ use of various healthcare, social and employment services during one year and to investigate sociodemographic and health-related predictors of user groups. Methods Administrative register data on the use of 22 distinct healthcare, social and employment services and on socio-demographic and health-related covariates from year 2018 were linked for all working-age residents of the municipality of Oulu, Finland (N = 119,740). K-means cluster analysis was used to group the study subjects into clusters, based on their yearly frequency of using each service. Multinomial logistic regression was used to assess the associations of sociodemographic and health-related covariates with cluster assignment. Results Five distinct clusters were identified, labelled ‘low to moderate users of healthcare’ (82%), ‘regular employment services users with moderate use of healthcare’ (10%), ‘supported employment services users’ (3%), ‘frequent users of healthcare, social and employment services’ (3%) and ‘disability and specialized services users’ (3%). Each cluster showed different patterns of service use and was also uniquely associated with sociodemographic and health-related covariates, reflecting distinct service user types. Conclusions The study identified five distinct groups of healthcare, social and employment services users in a working-age population. Knowledge of different user profiles and their determinants can help predict future need and use of services, coordinate and integrate services, and plan early interventions and prevention measures. This is important in order to save costs and improve the overall quality and effectiveness of services for groups with different care needs. Key messages • In terms of their use of healthcare, social and employment services, the working-age population can be classified into distinct groups, uniquely associated with various determinants. • Understanding the population’s use of different services can help predict future needs and improve coordination, integration and effectiveness of services in groups with different needs.

Family carer experiences of hospice care at home: Qualitative findings from a mixed methods realist evaluation

Background: Hospice-at-home aims to enable patients approaching end-of-life to die at home and support their carers. A wide range of different service models exists but synthesised evidence on how best to support family carers to provide sustainable end-of-life care at home is limited. Aim: To explore what works best to promote family carers’ experiences of hospice-at-home. Design: Realist evaluation with mixed methods. This paper focuses on qualitative interviews with carers (to gain their perspective and as proxy for patients) and service providers from 12 case study sites in England. Interviews were coded and programme theories were refined by the research team including two public members. Setting/participants: Interviews with carers (involved daily) of patients admitted to hospice-at-home services (n = 58) and hospice-at-home staff (n = 78). Results: Post bereavement, 76.4% of carers thought that they had received as much help and support as they needed and most carers (75.8%) rated the help and support as excellent or outstanding. Of six final programme theories capturing key factors relevant to providing optimum services, those directly relevant to carer experiences were: integration and co-ordination of services; knowledge, skills and ethos of hospice staff; volunteer roles; support directed at the patient–carer dyad. Conclusions: Carers in hospice-at-home services identified care to be of a higher quality than generic community services. Hospice staff were perceived as having ‘time to care’, communicated well and were comfortable with dying and death. Hands-on care was particularly valued in the period close to death.

Marketplace accessibility: a service-provider perspective

PurposeThis study aims to explore the strategies that service providers use to facilitate marketplace accessibility, and identify the key challenges in that process. The authors do so to develop a roadmap towards improved accessibility and disability inclusion in the marketplace.Design/methodology/approachThe authors conducted eight semi-structured interviews with service providers (curators, visitor service coordinators and access managers) at museums who run access programmes for customers with visual impairment (VI), along with an embodied duo-ethnography of those programmes.FindingsService providers foster autonomous, embodied and social access. Resource constraints, safety concerns and exposed differences between customers compromise access. To overcome these challenges, service providers engage in three inclusionary strategies – informing, extending and sensitizing.Research limitations/implicationsThis service provider- and VI-focus present limitations. Future research should consider a poly-vocal approach that includes the experiences of numerous stakeholders to holistically advance marketplace accessibility; and apply the marketplace accessibility findings upon different disabilities in other marketplace contexts.Practical implicationsThis study offers a roadmap for policymakers and service providers on: which types of access should and can be created; what challenges may be encountered; how to manage these challenges; and, thus, how to advance accessibility beyond regulations.Originality/valueThis study contributes a service provider perspective on marketplace accessibility that goes beyond removing “disabling” barriers towards creating opportunities for co-creation; an approach towards marketplace accessibility that fosters inclusiveness while considering the inherent challenges of that process; and an illustration of posthumanism’s empirical value in addressing issues of accessibility in the marketplace.

Quality of Life among Low-Income Older Residents in Subsidized Senior Housing: Rural vs. Suburban Comparisons

Older adults living in subsidized senior housing tend to be at risk for poor psychological well-being related to their advanced age and low income. This study aims to explore multilevel factors affecting perceived quality of life (QoL) among non-urban subsidized senior housing residents and to compare these factors between rural and suburban communities. Community/residential-level data were collected from the interviews with residential service coordinators (RSC) of five subsidized senior housing communities in the New England region: two rural and three suburban communities. Individual- and interpersonal-level data came from the survey with 82 residents. A mixed-methods approach was utilized. We used thematic content analyses for the interview data and multivariate ordered logit regression for the survey data. Our results showed that rural residence was positively associated with QoL (OR = 4.913, p<.01) even after controlling for all the individual-, interpersonal-, and community/residential-level factors. From RSCs’ perspectives, four main themes emerged, which could potentially contribute to better QoL among senior housing residents: access to services, social spaces for residents, inequitable connections to community resources, and social engagements among senior housing residents and with RSCs. Our findings contribute to the development of strategies to improve QoL among older adults living in rural/non-metropolitan subsidized senior housing.

Lessons learnt from a community-driven digital social connection pilot program for people living with dementia: A qualitative interview study with key stakeholders.

In response to COVID-19 and mandated physical distancing, a new digital social connection program was developed and implemented by the local community in a large regional town in western Victoria, Australia. This pilot program, the Digital Inclusion-Social Connections (DI-SC) program, aimed to support people living with dementia to use a digital device to access social connection activities. The objective of this study is to inform the local community implementing the DI-SC program of key stakeholder experience of DI-SC process and outcomes to support future development and potential translation of digital social connections programs for people living with dementia. Three semi-structured focus groups and two interviews were conducted with a total of fifteen participants. Data was transcribed verbatim and thematically analysed. Three main themes were identified describing factors as influencing the process and outcomes of the DI-SC program: understanding dementia; personal choice and control; and service planning and coordination. Six sub-themes were identified: matching capability; establishing a relationship; creating opportunities for different interactions; ownership of the device, program coordination and defining the volunteer digital mentor role. Key stakeholders perceived the DI-SC program as an acceptable way of supporting people living with dementia to engage in activities they found enjoyable promoting social connection with care partners and others. DI-SC program outcomes were impacted by inappropriate training and a lack of program coordination. The findings of this study may inform future development and implementation of digital social connection programs for vulnerable populations at risk of social isolation.

Impact on all-cause mortality of a case prediction and prevention intervention designed to reduce secondary care utilisation: findings from a randomised controlled trial

BackgroundHealth coaching services could help to reduce emergency healthcare utilisation for patients targeted proactively by a clinical prediction model (CPM) predicting patient likelihood of future hospitalisations. Such interventions are designed...

How Can We Better Serve Children with Disabilities? Public Library Accessibility Recommendations from Early Intervention Coordinators

ABSTRACT Service coordinators (SCs) play a vital role in assisting families in accessing and navigating the system of Early Intervention services that provide vital support to young children with disabilities and/or developmental delays (YCwD/DD). The study reports findings of focus group interviews with 14 SCs in three states in the United States that were subsequently coded and analyzed using a thematic analysis framework. SCs identified many ways that libraries support YCwD/DD through provisions of materials, services, spaces, and collaborative partnerships with community agencies. However, they pointed to additional measures libraries could take to better serve YCwD/DD and their families. Libraries might consider implementing changes to aspects of their policies and collaborative relationships in order to improve their responsiveness to the needs of YCwD/DD and their families.

Provision of mental health and psychosocial support services to health workers and community members in conflict-affected Northwest Syria: a mixed-methods study

BackgroundNorthwest Syria (NWS) is a conflict area with challenging political, economic, demographic and social dynamics. The region has a high number of internally displaced persons with increasingly disrupted delivery of basic services, including healthcare. Mental health needs have been increasing in the region while the infrastructure and capacity of the health sector has been negatively affected by the conflict. This study aimed to explore the provision of mental health and psychosocial support (MHPSS) services to communities in NWS (including healthcare workers) and to assess the experiences of beneficiaries with MHPSS services.MethodsThe study followed a mixed-methods research design that included qualitative and participatory methods (44 semi-structured interviews and a group model building workshop with 15 participants) as well as a survey with 462 beneficiaries.ResultsFindings suggested an improvement of MHPSS services in the region over the last few years due to the creation of a specific Technical Working Group for MHPSS that contributed to assessment of community needs and support of the MHPSS response. The key elements of this response were: (1) training non-specialized health workers to address the shortage in specialized providers; (2) securing funding and coordination of services between different organizations; and (3) addressing gaps in the availability and geographical distribution of other needed resources, such as medicines. While those elements contributed to improving access to services and the quality of services—especially among health workers seeking MHPSS services—findings suggested gaps in the sustainability of services and a need to scale up those interventions in an integrated approach.ConclusionThe study findings add to the evidence base on the challenges in scaling up MHPSS interventions and their long-term sustainability concerns. Priority actions should address the intermittent funding of the MHPSS response, incorporate MHPSS outputs and outcomes in the reimbursement of routine services, improve coordination between health partners and non-health actors in order to expand the scope of MHPSS response, and address the inequitable availability of resources in the region.

Acute Health Care Provision in Rural Long-Term Care Facilities: AScoping Review of Integrated Care Models.

We aimed to map integrated care models for acute health care in rural long-term care facilities (LTCFs) for future investigation. Systematic scoping review. Residential LTCFs in rural areas worldwide. The common health-related online databases were systematically searched complemented by a manual search of gray literature. Following the 5-stage framework of Arksey and O'Malley, the extent of included literature was identified and findings were summarized using qualitative meta-summary. A total of 35 references were included for synthesis, predominantly primary research on completed and ongoing projects reporting on integrated health care services in rural LTCFs. Incorporating previous research, we extracted 5 approaches of integrated acute-health care models: (1) Availability of Specialists, (2) Networks, (3) Quality Management (QM) and Organization, (4) Telemedicine, and (5) Telehealth. This research presents the result of a literature review examining integrated care models as a way to improve acute health care in LTCFs in rural areas. Integrated care models in rural settings can help face the challenging situation and fulfil the complex health care needs of LTCF residents by reducing fragmentation and thereby improve continuity and coordination of acute health care services. These results can guide policy making in creating interventions and support adequate implementation of care models by knowledge translation in health care.

Displaced Women and Sexual and Reproductive Health Services: Exploring Challenges Women With Sexual and Reproductive Health Face in Displaced Camps of Nigeria

Background: Displaced women are affected by sexual and reproductive health (SRH) challenges, often exacerbated by poor living conditions, limited access to healthcare, and cultural norms. The aim of this study was to explore SRH issues, the effects of displacement into camps on women’s SRH, and challenges with accessing and utilizing SRH services among women in camps for the displaced in Benue State, Nigeria. Methods: A qualitative phenomenological approach was employed to gain an in-depth understanding of the women’s SRH challenges, based on 12 focus group discussions between women of different age groups and eight in-depth interviews. The data were collected using tape recorders and notes. Data analysis followed a thematic approach. Ethical approval and appropriate consent were obtained for the study. Results: The majority of research participants stated that sexually transmitted disease/human immunodeficiency virus was the most serious SRH issue in the camp. Their stay in camp enhanced the women’s vulnerability and exposed them to sex in exchange for basic needs/palliatives, increasing their SRH challenges. Access to and use of SRH services were impacted by their migratory lifestyle, cultural and religious views, lack of SRH knowledge, and other difficulties. Short-term approaches to intervention, health providers’ poor communication, and attitudes were reported to affect SRH service use. Conclusion: There is an urgent need for comprehensive interventions to address SRH challenges among women in displaced settings, including proper coordination of humanitarian services, education on transactional sex, encouragement of men to participate in SRH initiatives, and expansion of access to services, as well as the training and hiring of culturally competent healthcare providers.

Rethinking environmental flow management strategies in reservoir operations from an integrated water quality perspective

River damming causes appreciable nutrient retention in reservoirs, increasing the risk of eutrophication in reservoir water. Environmental flow (e-flow) management strategies have been extensively studied to direct reservoir release to meet water quantity demands of downstream ecosystems. However, such strategies also impact reservoir nutrient transport and transformation as well as stored and discharged water quality, which has rarely been considered in existing e-flow management. This study combines a reservoir operation optimization model and a coupled hydrodynamic-eutrophication-sediment model to evaluate e-flow management strategies from an integrated water quality perspective. Multiple nutrients, water, and sediment processes are accounted for as well as the quality of both stored and discharged water. Five common e-flow strategies that focus on various ecosystem protection targets were used to generate operation scenarios. Subsequently, the coupled hydrodynamic-eutrophication-sediment model was used to simulate nutrient cycling processes and water quality under each scenario. Modeling results show that e-flow management strategies cause complex effects on reservoir nitrogen, phosphorus, and algal dynamics. In general, reservoir water quality was the worst in the scenario with largest e-flow release, implying that tradeoffs exist between water quantity and quality of reservoir release. Lower e-flow release resulted in reservoir storage level increases and promoted sediment nutrient release, but the effect was offset by the increase in the nutrient dilution capacity of reservoir water. Additionally, the comparison between inflow and discharged water quality showed that the reservoir contributed to reducing river nitrogen loads under low e-flow releases while increasing river phosphorus loads in all scenarios. The findings support e-flow management decision-making to account for both water quantity and quality targets as well as to coordinate reservoir services and ecological protection.

Aynı tarihte aynı serviste bulunan Covid-19 yatan hastaları ile sağlık çalışanlarında anksiyetenin karşılaştırılması

Aim: Demonstrating which population has the highest anxiety symptoms and its predictors is important for the coordination of psychiatric care and services. Hospitalized patients with Covid-19 and healthcare professionals caring for them are the two groups with the highest risk of psychiatric disorders during the SARS-CoV-2 pandemic. We aimed to assess the state and trait anxiety levels of Covid-19 patients and healthcare professionals simultaneously in the same Covid-19 ward of a tertiary center hospital.&#x0D; Materials and Methods: Given the nature of this observational single-center study, purposive sampling of all patients and staff in the Covid-19 ward between 5-10 April 2020 was planned. The data was collected via an online survey using “Sociodemographic Form” and “State-Trait Anxiety Inventory (STAI)”.&#x0D; Results: The state anxiety levels of hospitalized patients with Covid-19 were significantly higher than healthcare workers in t-test (p = .012) however this was resolved in regression analysis (β = .029, t = .19, p = .85). Not being in a marital bond (p = .035) and having a lifetime psychiatric disorder (p = .002) were predictors of state anxiety; older age (p = .006), being female (p = .007) and having a lifetime psychiatric disorder (p = .002) were associated with trait anxiety scores in patients and healthcare workers in the Covid-19 ward.&#x0D; Conclusion: Having a lifetime psychiatric disorder was the common item for both state and trait anxiety of patients, doctors, and nurses in the Covid ward. Psychiatrists should be accessible in the Covid-19 ward primarily for individuals whom they evaluated or treated before the pandemic.

Pengaruh Koordinasi Layanan Pendidikan terhadap Kualitas Pendidikan Dasar di Kecamatan Bantan Kabupaten Bengkalis

Coordination of education services is one of the tasks of the district coordinator in the field of education to map the quality of education in the district he leads. This research aims to measure how much influence the coordination of education services carried out by the sub-district coordinator in the field of education has on the quality of elementary education in the Bantan sub-district, Bengkalis district. The method used in this research is a quasi-experimental method. This method has nine stages, namely: literature review, identifying and limiting research problems, developing research hypotheses, making research designs, conducting pretests, conducting experiments, conducting posttests, processing and analyzing data, and drawing conclusions. The research sample consisted of 34 teachers, consisting of 17 teachers in the experimental class and 17 teachers in the control class. The data collection technique used was the observation of teacher quality. The research instrument used was the teacher quality observation sheet. The research results show that the coordination of education services carried out by sub-district coordinators has a significant effect on the quality of elementary education in the Bantan sub-district, Bengkalis district. The quality of elementary education is reflected in the quality of teachers who are currently studying masters in elementary education with a total of 11 teachers from the elementary school level and 6 teachers from the junior high school level.

268 Specialist stroke rehabilitation needs in a tertiary hospital—are needs being met?

Abstract Background Stroke specific rehabilitation is essential to recovery and return to independence following acute stroke. With increasing cases and improvements in stroke care rehabilitation needs are rising, placing significant pressures on acute stroke units and acute hospital services. We used a point prevalence study to assess the rehabilitation needs of our stroke service. Methods Patients admitted under the stroke service were identified using the electronic patient admissions system on February 17th, 2023. Data was collected by teams of two healthcare professionals. Data collected: demographics, ward location; most appropriate location of care—Hospital, Community, Rehabilitation Unit; Clinical Frailty Score (CFS); Rehabilitation Complexity Score (RCS); estimated Length of Stay (LoS). Results 53 patients admitted under the stroke service, 60% (32/53) patients were on the stroke unit, 40% (21/53) on an outlier ward, 9% (5/53) in the emergency department. Female 45% (24/53) Male 55% (29/53). Of patients &amp;gt;75 years 67% (22/32) had a CFS &amp;gt; 4. 41% (22/53) had primary rehabilitation needs, 30% (16/53) community, and 28% (15/53) hospital care. 17% (9/53) had an estimated LoS &amp;gt; 3 months of those 55% (5/9) had primary rehabilitation needs that could be in a rehabilitation unit. Average RCS 9.7, average RCS 12.6 for patients with an estimated LoS &amp;gt; 3 months. Conclusion Our study shows that limited access to suitable rehabilitation facilities has a direct impact on the coordination of stroke services in the acute setting. A high proportion of patients were not located on the stroke unit, an intervention shown to reduce mortality and disability. This study highlights the importance of ongoing improvement of rehabilitation services.