Improving the provision of accurate driving advice to cardiac inpatients on discharge – a matter of both public and patient safety

Abstract

Abstract Background/Introduction Cardiovascular disease can have a significant impact on an individual's ability to drive. The Driver and Vehicle Licensing Agency (DVLA) provides clear guidance on the legal obligation and limitations of drivers with cardiac conditions and the General Medical Council (GMC) sets out the responsibility of physicians' in providing and documenting this advice clearly. Failure to adhere to these requirements has safety implications for both patients and the public, and medico-legal implications for practitioners. Purpose We sought to audit the percentage of patients receiving the correct driving advice on discharge and improve any inadequacies found through a two-stepped intervention in a tertiary cardiac centre Methods A retrospective analysis of the clinical notes of patients discharged from cardiac wards over a 3-week period was conducted and documentation of accurate driving advice was assessed. Using Plan-do-study-act (PDSA) methodology, two cycles of change were implemented. During PDSA cycle 1, a poster outlining cardiology specific DVLA advice was created. The poster was displayed throughout all cardiac wards to educate and encourage healthcare workers to communicate and document driving advice to patients. During PDSA cycle 2 a teaching session highlighting relevant DVLA advice and the importance of documenting this advice was delivered to all healthcare workers within the Cardiology department. The poster was also integrated into the department's staff induction booklet. Results The baseline audit showed that only 2.5% (1/40) of discharge documentation included accurate driving advice. After the second PDSA cycle, there was a statistically significant improvement to 52.5% (21/40) (P<0.0001). Qualitative feedback was obtained in the form of questionnaires and it was found that confidence and knowledge of driving advice improved amongst the junior doctor cohort. Conclusion This study highlights the medico-legal implications for physicians and the risks to patient and public from inadequate documentation of driving advice in cardiac patients. We have demonstrated a quick and effective method to improve documentation of driving advice in cardiology patients which is easily reproducible in different settings. Funding Acknowledgement Type of funding sources: None.