Vehicle Licensing Agency Research Articles

Discrepancy between medical conditions self-reported by bus drivers and medical records.

Medical incapacity at the wheel is a rare but high-profile factor in accident causation. The UK Driver and Vehicle Licensing Agency (DVLA) does not require a review of medical records on the application for a bus licence, but applicants sign a self-declaration of medical history. There is debate over what, if any, verification of medical information is required for doctors who complete the medical assessment. To assess how self-declaration compares against General Practitioner (GP) patient records for a series of bus drivers undergoing driver licensing assessment in a 12-month period. Review of GP reports received for bus driver medicals undertaken in a 12-month period between 1 July 2022 and 30 June 2023. Of the 145 medicals undertaken, 12 (8.3%) GP reports contained undeclared medical conditions that required further evaluation and may have impacted on fitness to drive. Studies into the contribution of medical incapacity at the wheel to vehicle accidents are sparse, as, thankfully, are the events themselves. Nevertheless, given the updated General Medical Council guidance to doctors on confidentiality and public protection responsibilities, and evidence to suggest that doctors' knowledge of the DVLA guidelines is poor, it might be pertinent for the DVLA to reconsider its approach to driver self-reporting in some circumstances, given the discrepancy highlighted here.

AKT question relating to the Driving Vehicle Licensing Agency (DVLA) criteria

AKT question relating to the Driving Vehicle Licensing Agency (DVLA) criteria

On the road to equity: examining income-related inequalities in ownership of safer cars

Abstract Using administrative Driver and Vehicle Licensing Agency (DVLA) data, matched with the UK Household Longitudinal Study (covering the period between 2013 and 2015), we estimate income-related inequalities in ownership of safer cars. We also apply regression-based decompositions to explore the source of inequalities. We find systematic pro-rich inequalities in ownership of safer cars that are almost entirely explained by the car's price and year of manufacture. A range of household-level variables, including demographics, risk aversion, time preference, personality traits, cognitive ability and education, play a much less pronounced contribution to overall inequality. The observed inequity in safer car ownership with potential effects on the socio-economic gap in road-traffic injuries may require regulatory interventions.

Intermittently scanned continuous glucose monitoring and hypoglycaemia awareness in drivers with diabetes: Insights from the Association of British Clinical Diabetologists Nationwide audit.

Frequent hypoglycaemia results in disruption to usual hypoglycaemic autonomic responses leading to impaired awareness of hypoglycaemia, which is associated with an increased risk of severe hypoglycaemia requiring third-party assistance (SH). The UK Driving and Vehicle Licensing Agency (DVLA) does not permit car driving if they have either a complete loss of hypoglycaemia awareness or more than one SH event a year. The FreeStyle Libre (FSL) Association of British Clinical Diabetologists (ABCD) Nationwide Audit consists of data collected by clinicians during routine clinical work, submitted into a secure web-based tool held within the National Health Service (NHS) N3 network. Analysis of paired baseline and follow-up data for people with type 1 diabetes who also held a driving licence was undertaken. The study consisted of 6304 people who had data recorded about driving status from 102 UK specialist diabetes centres, of which 4218 held a driving licence: 4178 a group 1, standard licence, 33 a group 2, large lorries and buses, seven a taxi licence; 1819 did not drive. Paired baseline and follow-up data were available for a sub-cohort of 1606/4218. At a mean follow-up of 6.9 months [95% CI (6.8, 7.1)], the Gold score had improved (2.3 ± 1.5 vs. 2.0 ± 1.3 p < .001), and the number of people who experienced an SH episode was also significantly lower (12.1% vs. 2.7%, p < .001). This study suggests that intermittently scanned continuous glucose monitoring may improve impaired awareness of hypoglycaemia and reduce the number of people with type 1 diabetes with a driving licence experiencing a severe hypoglycaemic episode.

P.137 Implementation of Canadian driving guidelines following cranial procedures: a systematic review and survey of Canadian neurosurgeons

Background: Following craniotomy, there is widespread agreement that post-operative neurological impairments require specialized evaluation to evaluate fitness to drive. However, for patients who had a craniotomy and do not have neurological deficits or known seizures, there is less consensus as to when return to driving is safe. In this study, we aim to review existing guidelines regarding driving post-craniotomy and assess the current practices for post-craniotomy recommendations in Canada. Methods: Our study has three components: 1) systematic review of existing guidelines for return to driving after cranial procedure; 2) review of primary evidence (cohort studies) regarding seizure risk following a craniotomy, depending of the underlying pathology; 3) online questionnaire distributed to Canadian neurosurgeons by the Canadian Neurosurgery Collaborative (CNRC) network. Results: Our systematic review unveiled various sets of guidelines for driving after a craniotomy. For instance, UK Driving and Vehicle Licensing Agency writes into law specific guidelines for return to driving varying based on underlying pathology. Their results were drawn from large cohort studies measuring the occurrence of post-operative seizures after craniotomy for a variety of conditions. The questionnaire is currently being distributed to Canadian neurosurgeons. Conclusions: Our study lays the first steps towards the development of Canadian guidelines for return to driving post-craniotomy.

UK exceptional case driving application outcomes in post-stroke homonymous hemianopia: results from a clinical study

Purpose We report results in relation to returning to driving in the UK under the exceptional cases rule for visual field loss. Methods The Hemianopia Adaptation Study is a prospective clinical study recruiting adult stroke survivors with new onset homonymous hemianopia. The mobility assessment course (MAC) was used to measure navigational scanning. Car drivers were offered a 1-year post-stroke assessment to consider referral for driving assessment. Results Of 144 participants, 51 were eligible for driving assessment, with 13 (25.4%) accepting appointment for UK Driving and Vehicle Licensing Agency (DVLA) referral. A statistically significant difference in gender and baseline Barthel (stroke severity) scores was found between those requesting referral and those declining (p = 0.046; p < 0.001). MAC outcomes were significantly different, with those referred having a lower percentage of target omissions (9.0%) and faster mean course completion time (46.0 s), than those not referred (28.3%/72.5 s) (p = 0.006/p < 0.001). Twelve of the 13 referred were offered a driving assessment by the DVLA. All 12 passed and returned to driving. Conclusions It is possible for individuals with post-stroke homonymous hemianopia to return to driving, where exceptional cases criteria are met. There is evidence to support use of the MAC as a clinical measurement of adaptation. IMPLICATIONS FOR REHABILITATION Individuals with post-stroke homonymous hemianopia should be fully informed regarding driving regulations that can differ between countries and sometimes different states within a country, as well as provided with the support and opportunity to consider a return to driving if appropriate. Professionals providing care within the stroke multi-disciplinary team should be aware that it is possible for patients with homonymous hemianopia to return to driving, when exceptional cases criteria are met. The mobility assessment course (MAC) should be considered as a clinical measurement of adaptation in homonymous hemianopia. A cut-off score of ≤25% omissions on MAC could be employed to determine those likely to adapt to hemianopia long-term and potentially return to driving.

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

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&amp;lt;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.

Driving Risk Assessment and Advice Provision for Inpatients Based on Features of Illness, Treatment and Driver and Vehicle Licensing Agency (DVLA) Guidelines

AimsThe aim of the project was to improve the routine incorporation of driving advice based on Driver and Vehicle Licensing Agency (DVLA) guidance into discharge planning by responsible inpatient teams. This would optimize patient safety, demonstrate good clinical practice (trust and professional body values) and minimize/prevent the emergence of accidents/unfair loss of licenses/unfair attribution of driving accidents caused by people who have been under recent or ongoing inpatient care.MethodsThe following questions: “Do you have a valid license”, “Do you own/have access to a vehicle”, “Do you currently drive” were developed as a standard template for gathering patients’ driving information.These questions were embedded within: 1.Barriers to ward discharge discussions2.Trust-wide communications via screensaver and circularAnswers to these questions were to be clearly documented on patient's records to serve as prompts for the responsible discharging team to take up providing the appropriate advice.After a specified period, the electronic discharge notification (EDN) database was searched for patients with relevant diagnosis who were discharged from all the general adult/older adult acute inpatient wards within a specified period. The patients’ records were then checked for documentation of relevant driving information evidenced by documentation of answers to the screening questions as well as recorded evidence of DVLA discussion/advice held since date of diagnosis or admission.The standards audited against were all patients: 1.should have their driving licence status recorded during their admission2.should have their access to a vehicle recorded during their admission3.with a relevant mental health diagnosis should have a record of advice regarding driving given in bespoke and DVLA informed manner during ward discharge planning by the responsible discharging team4.should have documentation of the outcome of the driving advice given by the responsible team in their recordsResults28 patients with relevant DVLA notifiable mental health conditions were audited. 11% (n = 3) had driving licence status recorded. 14% (n = 4) had access to a vehicle recorded. 7% (n = 2) had driving advice given. Only one patient had outcome of driving advice recorded. No best practice was identified.ConclusionDocumentation of driving information, DVLA signposting advice and outcome for patients with relevant mental health diagnosis is a crucial part of patient risk assessment and management as these patients are not free from posing a driving risk on discharge. The trust is implementing actions to improve the routine incorporation of driving advice based on DVLA guidance into discharge planning.

Do We Know if You Drive? a Quality Improvement Project Improving Compliance With DVLA Guidelines

AimsBackground: The Driving &amp; Vehicle Licensing Agency (DVLA) states: “Doctors and other healthcare professionals should: advise individuals on the impact of their medical condition for safe driving ability and also advise the individual on their legal requirement to notify DVLA of any relevant condition”. Within mental health, the guidance states that depression or anxiety associated with “Significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts” must be reported to the DVLA. Aims: Identify whether information was collected on driving status of patients presenting with depression/anxiety and self harm. Identify whether accurate advice was provided and documented. Implement changes that would improve compliance with guidance.MethodsWe reviewed notes to collect baseline data for 3 weeks prior to commencing interventions, then weekly for 2 months from November 2021. Cases were defined as: those presenting to Liaison Psychiatry (LP) with an act of self-harm either on antidepressants or with a confirmed diagnosis of depression/anxiety on their record. Each week, the notes of 10 cases were reviewed for evidence of documentation of driving status and advice regarding DVLA guidelines.Weekly InterventionsWeek 1: Email communication to team highlighting the guidance, responsibilities and where to document.Week 2: Driving status discussed in handover daily to increase awareness and identify/address concerns.Week 3: Repeat email to team.Week 4: DVLA guidance posters placed in LP office.Week 12: Teaching session by Occupational therapist from regional driving assessment centre.ResultsData were analysed for 90 patients over 9 weeks. 52% were female, and average age was 33 years. Relevant documentation was only made on week 1 (10%) and week 4 (20%). No documentation of either driving status or advice given were made in any of the other weeks analysed.ConclusionAchieving compliance with guidance was difficult. Email communication was the most effective intervention. A group discussion to identify drivers of poor compliance found that clinicians failed to ask as the questions were not routine practice, and some voiced concerns about the potential implications of advice (worsening therapeutic relationship or increasing social isolation/implications for employment). Future plans include adding a prompt about driving on the electronic risk assessment, and specific training in the staff induction.

A DVLA Notification Audit in Forensic Supported Accommodation

AimsThe Driver and Vehicle Licensing Agency (DVLA) in England, Scotland and Wales are legally responsible for deciding if a person is medically unfit to drive. This means they need to know if a person holding a driving licence has a condition or is undergoing treatment that may now, or in the future, affect their safety as a driver. The driver is legally responsible for telling the DVLA about any such condition or treatment. Doctors should therefore alert patients to conditions and treatments that might affect their ability to drive and remind them of their duty to tell the appropriate agency. Patients with acute schizophrenia or an acute psychotic disorder must not drive and must notify the DVLA. In alliance with the above, the GMC advises that clinicians have a responsibility to explain the above information to the patient and inform them that they have a legal duty to inform the DVLA. Doctors should also inform patients that relevant medical information may need disclosing about them to the DVLA if they continue to drive against advice, and any advice given should be documented. The main objective of this audit is to identify if notification of DVLA for forensic patients living in supported accommodation, is in accordance with the DVLA guidelines.MethodsA total of 12 residents living in community forensic supported accommodation who have a notifiable diagnosis were included. Data collection took place in September 2021, looking through all previous records relating to the search words “DVLA”, “drive”, “driving” and “license”. Data audited were from the trust's electronic patient records.ResultsDiagnoses included paranoid schizophrenia, delusional disorder and personality disorder. Antipsychotic medications included Olanzapine (oral and IM), Clozapine and Zuclopenthixol +/- antidepressants. Legal status included community treatment orders (civil section), voluntary community patients and those on a conditionally discharged restriction under secretary of State supervision. Two patients held full driving licences and a further two held provisional licences, with DVLA documented discussions and notification compliance at 100%. The remaining eight patients had no documentation regarding driving nor DVLA discussions or notification.ConclusionThis audit found that DVLA discussions are not currently well documented, with only four patient records that have this recorded. Although it is the clinical team's responsibility to advise the patient to notify the DVLA, it is ultimately the patient's responsibility to notify the DVLA themselves. DVLA discussions need to be had regardless of driving status and documentation should reflect this.

Documentation of Driving Status and of Fitness to Drive Following Admission of Patients to Clock View Hospital - How Are We Doing?

AimsDeveloping a mental illness and being commenced on psychotropic medication are factors that may interfere with the ability of an individual to drive safely as both can impact information processing, psychomotor actions and social interpretation. The Driver and Vehicle Licensing Agency (DVLA) suggests that certain medical conditions require driving licence holders to notify them for further assessment of their ability to drive. DVLA notifiable mental disorders include psychosis, schizophrenia, bipolar disorder, dementia and personality disorders. The doctor's legal duty is to assess the patient for any relevant diagnosis, inform the patient of their duty to report their medical condition to the DVLA and for the doctor to comply with the legal duty to inform the DVLA of any patient who won't or can't notify the DVLA of their medical condition. The authors conducted a quality improvement project to evaluate and improve the number of fitness to drive assessments completed for patients admitted to the five wards (three general adult, one older adult and the Psychiatric Intensive Care Unit) at Clock View Hospital.MethodsThe electronic (RiO) record for each inpatient on the five wards was scrutinised for: whether the patient's driving status was established on admission; whether the patient was notified of the DVLA rules if they did drive; whether the patient agreed to fulfil their duty of notification and, in instances where they were not, whether the medical professional had taken appropriate steps to address this.Results74 patients on the five wards were included in the sample. Only nine of the 74 patients had driving status documented on admission. Three of these nine patients were noted to be driving or learning to drive and were not notified of the DVLA rules. Four of the nine patients were no longer driving and so discussion about DVLA guidance was unnecessary. The remaining two patients were confirmed to be driving and informed of the DVLA regulations. Both patients agreed to comply and therefore no further action was indicated.ConclusionA review of current practice indicates a deficit in incorporating driving status and fitness to drive assessment into the clerking proforma following admission to Clock View Hospital. The second half of this cycle will implement change and raise awareness amongst inpatient medical and nursing staff of the need to consider this important issue prior to discharge. A re-assessment of the effectiveness of these changes will be carried out in the future.

AKT question relating to Driver and Vehicle Licensing Agency (DVLA) rules

AKT question relating to Driver and Vehicle Licensing Agency (DVLA) rules

AKT answer relating to Driver and Vehicle Licensing Agency (DVLA) rules

AKT answer relating to Driver and Vehicle Licensing Agency (DVLA) rules

Driving and glaucoma in the UK: a national survey of clinicians' advice and guidance to patients.

Driving standards policy is set by the Department for Transport and executed by the Driving and Vehicle Licensing Agency (DVLA). Professional bodies recognise the challenges that clinicians face when advising patients with glaucoma about driving. This study explored clinicians' knowledge and confidence around driving standards and their approach to advising and guiding patients. Cross-sectional online survey of all United Kingdom and Eire Glaucoma Society (UKEGS) members. The survey remained open for five weeks (22/02/21-27/03/21). Anonymised data were exported to Microsoft Excel for analysis. Out of 91 respondents (minimum response rate 20.2%), 53 (58.2%) were glaucoma consultants, 2 (2.2%) general consultant ophthalmologists, 4 (4.4%) ophthalmology fellows, 5 (5.5%) ophthalmology trainees, 19 (20.9%) optometrists, and 8(8.8%) 'other' categories (one SAS doctor, six specialist doctors, one nurse specialist). 58.2% reported that the visual standards for driving were 'very familiar'; 40.5% were 'moderately familiar'; one(1.2%) was only 'somewhat familiar'; none were completely unfamiliar. A total of 38 (41.8%) respondents were highly confident in giving advice on fitness to drive; 51 (56.0%) were moderately confident; 2 (2.2%) had only limited confidence. Over 25% review patients not meeting driving standards in every glaucoma clinic, over 50% identifying abnormal visual fields as the main reason. Our study found that most clinicians are familiar with DVLA driving standards. However, busy clinical environments limit detailed discussion about this, leading to only one in four clinicians being very confident to broach the subject with patients in clinic. A range of patient education modalities were suggested, which may help simplify advice provision for glaucoma patients.

Substance misuse and driving

Drug misuse is common in the UK; inevitably, general practitioners treat patients who misuse drugs. Drug misuse and dependence can seriously impair driving ability. Driving while impaired by drug use poses a risk of criminal prosecution, as well as a risk of death or injury to the driver, their passengers and others. As doctors we have a duty of care to our patients and we are generally bound by confidentiality. However, we also have a wider duty of care to protect the general public from serious harm. This article looks at UK law alongside guidance from the General Medical Council and Driver and Vehicle Licensing Agency to guide medical practice around this difficult area.

Effectiveness of an intervention to reduce accidents in bus drivers.

Medical incapacity at the wheel is a small but significant factor in accident causation. To mitigate against this, in July 2017 a UK-based bus operator changed its medical assessment policy, requiring all future medicals to include a request to the General Practitioner (GP) for information about any conditions in the medical record which could affect fitness to drive. To evaluate the impact of the change in policy on accident rates. Accident data were obtained over a 5-year period, with information on age and length of service of drivers, from three bus depots. Monthly accident rates, before and after the change in policy were compared with the Wilcoxon matched pairs test, and a line of best fit/R2 obtained via a scatter graph. Although a general downward trend in accident rates was seen, there was no statistically significant difference between the overall accident rates in the 12 months before and after the policy change in July 2017 (P-value = 0.519, significance level P < 0.05). The downward trend in accident rates observed over the study period could not be attributed to the change of policy. However, this intervention warrants further scrutiny due to the potential consequences of passenger service vehicle accidents. Evidence suggests that professional awareness of the UK Driver and Vehicle Licensing Agency fitness to drive standards can be limited, so requesting GP input into driver medicals may raise awareness of these standards from an occupational health perspective.

Improving DVLA advice provided to the patients with acute coronary syndrome upon discharge

Acute coronary syndrome (ACS) and coronary intervention can significantly impair patients' ability to drive and, therefore, the Driver & Vehicle Licensing Agency (DVLA) provides relevant guidance for patients and healthcare professionals on driving in order to safeguard patients, passengers and public in general. The initial pre-teaching cohort analysis revealed that 12.9% of the discharge summaries had documented driving advice and only 3.23% were in accordance with the DVLA guidance. Our primary aim was to increase the provision of appropriate driving advice to >90%. Secondary aims were to improve the quality of the written advice and to increase junior doctors' awareness and confidence in doing so. We created a template with standardised driving advice with specific guidance for group 1 and group 2 drivers, delivered formal and informal teaching, and distributed information leaflets. These measures led to an overall improvement in provision of correct advice to >90%. We demonstrated how simple measures of introducing a standardised driving advice template and conducting formal and informal teaching could significantly improve the quality of current practice pertaining to the DVLA's driving restrictions in ACS patients. The successful strategies employed by us can be utilised by other trusts across the UK to promote person-centred care and improve patient safety.

Are patients with brain tumours being given timely DVLA advice?

Abstract Aims Over 11,000 patients are diagnosed with a primary brain tumour annually in the UK, with many more being diagnosed with a secondary brain tumour. UK law stipulates that all individuals with a brain tumour must inform the Driver and Vehicle Licensing Agency (DVLA) and may be required to surrender their driving license depending on their specific tumour and symptoms. Despite this guidance, we found that patients continue to arrive at the neuro-oncology clinic without the correct DVLA advice being given. This can potentially lead to patients with brain tumours continuing to drive on the public highway, which poses a severe hazard as the risk of seizures could endanger the public. This retrospective study looks to review what information was provided to patients with brain tumours upon initial diagnosis and determine the adequacy of this; ultimately aiming to improve the quality of information given to future neuro-oncology patients. Method A structured questionnaire was designed, asking patients who have been treated for a brain tumour at the Queen Elizabeth Hospital in Birmingham about any information they received about driving when they were first diagnosed. The questionnaire comprised of 11 questions designed to gather an understanding of what information was given to patients about driving. The study secured local audit approval. 75 patients identified from the weekly neuro-oncology MDT list were contacted. All patients included in this audit were required to stop driving and inform the DVLA about their condition as per the DVLA guidelines. Their responses were collated and analysed. Using this data, we determined if there were inadequacies in the information that was given to these patients about driving, and how this process may be improved in the future. Results 60 patients (80%) possessed driving licenses when first diagnosed and 17% of these (n=10) were not told to stop driving; 8 of whom were diagnosed in primary/secondary care. 39 patients (65%) were first diagnosed in primary/secondary care, however, only 21% of these (n=8) were told to stop driving by primary/secondary care consultants. The remaining 31 patients (81%) were only told to stop driving after referral to tertiary care, by consultant neurosurgeons at the Queen Elizabeth Hospital. Conversely, of the 12 patients first diagnosed at the Queen Elizabeth Hospital, 85% were told to stop driving at diagnosis, suggesting a notable difference in informing patients between primary/secondary care and tertiary care. Patients also commented on the quality of the information received, as 10 individuals (21%) mentioned needing more information about getting their license back, and 5 individuals (11%) mentioning being given conflicting or incorrect information from different members of the MDT. Conclusion The results show that in practice, there are inconsistencies about mandatory DVLA advice which should be clearly provided to patients with a new diagnosis of a brain tumour. Only 78% of patients were told to stop driving at diagnosis, suggesting that the remainder could be liable to continue driving despite their diagnosis. Furthermore, many patients diagnosed in primary/secondary care are not being told to stop driving until after referral to tertiary care which can take weeks, causing delays in them being given this information, which can pose risks to themselves and the public. These delays may be alleviated by giving patients a simplified resource when they are first diagnosed which clearly explains the driving rules. We therefore propose developing a one-page resource based on DVLA guidance and distributing this to patients and referring healthcare professionals at first diagnosis. A subsequent re-audit can evaluate if this intervention improves the current situation.

57 A Closed Loop Audit of Post-Operative Driving Advice Documentation

Abstract Aim The Driving and Vehicle Licensing Agency state post-operatively it is between the patient and doctor to establish when would be safe to resume driving, providing recovery does not exceed three months. This audit aimed to assess and improve the documentation rate of driving advice in the discharge summaries given to patients post abdominal surgery. Method Retrospective data collection from electronic records over the months of August and September 2020. 132 discharge summaries were screened to assess the baseline rate of verbal/documented driving advice given on discharge. Following the 1st cycle, posters encouraging the inclusion of driving advice and demonstrating how to access driving advice to discharge summaries were developed and distributed across the surgical wards. A 2nd cycle re-audit was conducted in October 2020 to measure the effect of change, and a further 3rd cycle audit was conducted in November 2020. Results 1st cycle included 132 patients. 62% had documented advice on their discharge summaries, while 38% had no proof of driving advice. After intervention, 2nd cycle included 30 patients. Results showed a significant increase in advice documentation (80%). A 3rd cycle was carried out with 47 patients. This showed a reduction in advice documentation (66%). Conclusions Driving advice on discharge in post-operative patients is crucial part of patient safety. Implementation of intervention has increased the documentation of driving advice showing enhancing patient safety. However, 3rd cycle after registrar’s changeover showed a decrease in the rate of documentation. A teaching session is planned for new doctors followed by 4th cycle.

A case report of Carotid Blow-Out Syndrome whilst driving: A cautionary reminder of the Driver and Vehicle Licensing Agency (DVLA) regulations

Carotid Blow-Out Syndrome (CBS) is a life-threatening complication of head and neck cancer. We report the case of a patient who suffered a fatal haemorrhage whilst driving, review the law and role of healthcare professionals in preventing such events.