Background: Stroke survivors often require rehabilitation to address the physical, cognitive, and social impacts of stroke. The Stroke Foundation recommends the use of the Assessment for Rehabilitation Tool (ART), however the team processes for the assessment of need and referral for rehabilitation has rarely been explored.

Aims: This study is the qualitative arm of the project “Building Efficient and Equitable Pathways to and through Rehabilitation in Stroke” (BEEPRS). The aims were to: (1) explore the processes and experiences of acute stroke teams around referral to post-stroke rehabilitation; and (2) explore the processes and experiences of rehabilitation clinicians, about acceptance of patients for rehabilitation.

Methods: An ethnographic study was conducted across five public acute stroke units in Queensland. Case conference/team meetings were observed at each site, and 32 interviews were conducted with the acute stroke team members, and those responsible for conducting or reviewing rehabilitation assessments.

Results: Wide variations in rehabilitation assessment and referral practices exist between hospitals, with only one site using the ART. The relationships within and between the acute and rehabilitation teams impact on referral practices, with communication and trust being important factors for all parties. Clinicians at all sites expressed the belief that almost all patients have rehabilitation potential, however gaps and barriers exist which add complexities to decision-making.

Conclusion: This study provides a rich description of the complex process of decision-making about rehabilitation referral and assessment after stroke. Understanding the current practices can help guide service improvements to build efficient and equitable access to rehabilitation.