Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving

Abstract

Objective: A frequently overlooked factor contributing to traffic crashes is driver medical conditions, including cognitive and physical impairments, which can compromise individuals’ ability to drive safely. Clinicians are in a critical position (and often legally mandated) to identify patients with impairments that may affect their driving ability and counsel them on appropriate next steps. However, prior studies revealed that provider-patient discussions about driving occurred relatively infrequently and that clinician recommendations about when patients could resume driving varied substantially (Chen et al. 2008; Drazkowski et al. 2010). This research aimed to document current driver fitness assessment practices among neurology and neurosurgery clinicians at an academic medical center, with the overall purpose of informing quality improvement efforts.

Methods: A cross-sectional, anonymous survey was distributed to physicians and advanced practice providers working in the neurosurgery and neurology departments of a large, Pennsylvania-based academic medical center. Survey question domains included: 1) frequency of discussions about driving, 2) comfort discussing driving with patients, 3) criteria used to assess patient fitness to drive, 4) driver rehabilitation program referral practices, and 5) Pennsylvania Department of Transportation (PennDOT) reporting.

Results: The survey revealed that although most providers (68%) had high levels of perceived responsibility for counseling patients about driving, a minority regularly discussed driving issues with their patients (19% prior to discharge, 49% during clinic visits). In addition, only about half (54%) of providers reported having ever filed a report about a patient with the PennDOT, despite Pennsylvania’s mandatory driver reporting law. Likelihood of PennDOT reporting was found to be strongly associated with provider knowledge of Pennsylvania unsafe driver reporting laws (p < 0.001).

Conclusions: These findings highlight a need to enhance standard of care practices related to driver screening, counseling, and reporting. Overall, providers recognized the importance of their role in advising patients about safe driving and desired standardized protocols for guiding conversations about driving with patients, PennDOT reporting, and referring patients to driver rehabilitation services.

Keywords:

• Driver reporting
• driver rehabilitation
• PennDOT
• medically impaired drivers
• quality improvement

Acknowledgments

Thank you to the Penn Medicine Neurosurgery and Neurology Departments for their participation in this project. Thank you to Eileen Maloney–Wilensky, MSN, ACNP-BC for helping facilitate the distribution of the survey among providers. Thank you to Shukai Cheng, MS and Frances Shofer, PhD for providing guidance on the statistical methods used in this paper. And thank you to Rochelle Sobel for serving as an inspiration to advocate for better road safety practices and honor the many whose lives have been taken on the roads.

Data availability statement

Data and specific statistical methods used in this study may be shared upon reasonable request.

Disclosure statement

There are no conflicts of interest to disclose.

Additional information

Funding

A $300 research grant was obtained from the University of Pennsylvania’s Master of Public Health program to conduct this research.