Vusirikala Amoolya, Backhouse Mark, Schimansky Sarah
North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
BMJ Open Qual. 2018 Mar 18;7(1):e000162. doi: 10.1136/bmjoq-2017-000162. eCollection 2018.
Certain cardiac conditions can limit patients' ability to drive. It remains the doctors' responsibility to advise patients of any driving restrictions and is particularly important after certain diagnoses or procedures. We identified that the quality of documented advice was variable and frequently no written driving advice was recorded on discharge. It was apparent that there was a lack of awareness and knowledge of the current Driving and Vehicle Licensing Agency (DVLA) guidance among junior doctors. We therefore designed a quality improvement project using Plan-Do-Study-Act (PDSA) methodology to improve the provision of driving advice on discharge from a cardiology ward by focusing on staff education. After collecting baseline data, we created a template with cardiology-specific DVLA advice. During the second PDSA cycle, we improved the electronic template and also introduced a hard copy on the ward. During the third PDSA cycle, we incorporated information on DVLA guidance in the specialty induction session. We also evaluated junior doctors' confidence of providing driving advice before and after this intervention. Baseline measurements showed that 10% (9/92) of all discharge summaries included driving advice. This improved to 49% (34/69) after the third PDSA cycle. Importantly, after receiving information on driving advice in the induction, junior doctors felt more confident in providing driving advice to cardiology patients on discharge. In conclusion, the provision of driving advice on discharge is an important element of patient safety. However, clinicians' knowledge and awareness of current DVLA guidance is often limited. We demonstrated a significant increase in the provision of driving advice by introducing a standardised template.
某些心脏疾病会限制患者的驾驶能力。告知患者任何驾驶限制仍是医生的职责，在某些诊断或治疗程序后这一点尤为重要。我们发现记录的建议质量参差不齐，出院时经常没有书面的驾驶建议记录。很明显，初级医生对现行的驾驶与车辆牌照管理局（DVLA）指南缺乏认识和了解。因此，我们设计了一个质量改进项目，采用计划-执行-研究-行动（PDSA）方法，通过聚焦员工教育来改善心脏病房出院时驾驶建议的提供情况。收集基线数据后，我们创建了一个包含心脏病学特定DVLA建议的模板。在第二个PDSA循环中，我们改进了电子模板，并在病房引入了硬拷贝。在第三个PDSA循环中，我们在专科入职培训中纳入了有关DVLA指南的信息。我们还评估了初级医生在此次干预前后提供驾驶建议的信心。基线测量显示，所有出院小结中有10%（9/92）包含驾驶建议。在第三个PDSA循环后，这一比例提高到了49%（34/69）。重要的是，在入职培训中收到有关驾驶建议的信息后，初级医生在为心脏病患者出院时提供驾驶建议方面更有信心了。总之，出院时提供驾驶建议是患者安全的重要组成部分。然而，临床医生对现行DVLA指南的知识和认识往往有限。我们通过引入标准化模板证明了驾驶建议的提供有显著增加。
