Pennsylvania is one of six U.S. states that requires clinicians to notify the state department of transportation about patients with medical conditions that could impair their ability to drive safely. Because of this, we are interested in understanding how clinicians, particularly neurosurgery and neurology providers, approach decisions related to patient fitness to drive.
Our research team recently published a paper in Traffic Injury Prevention that describes the results of a survey which aimed to understand neurosurgery and neurology providers’ knowledge and attitudes about fitness-to-drive assessments, including the frequency with which they reported patients to the Pennsylvania Department of Transportation (PennDOT) and what resources are needed to improve their practices.
Driving Risks with Neurological Impairments
Neurological impairments can adversely affect numerous skills important for safe driving, including attention, hand-eye coordination, processing speed, safety awareness, and judgment. For example, multiple studies report that individuals who have suffered traumatic brain injuries (which can result in such impairments) are involved in a greater number of road crashes than individuals who have not. There have also been longstanding concerns about an association between seizure disorders and elevated road crash risk, which prompted several U.S. states to impose driving restrictions on individuals who have experienced a recent seizure.
Referrals to PennDOT
In our study, we found that:
- Only 20% of inpatient providers and 50% of outpatient providers usually or always discussed driving with patients.
- 54% of providers reported having ever filed a report about a patient with PennDOT.
- Providers cited concern for seizures as the most common reason to initiate a discussion about safe driving or to report a patient to PennDOT.
- Familiarity with reporting laws was significantly associated with likelihood of reporting to PennDOT.
- About one-third of providers had referred a patient to a driver rehabilitation program within the last year, and only about half had received some form of informal training (e.g., independent reading/advice from a mentor or colleague) on the programs.
Future Directions For Providers
We asked providers what tools or information they thought would help them feel more comfortable about discussing driving restrictions with patients. The following ideas were suggested most frequently:
- Handout for patients containing information about driving guidelines
- Information for providers about driver reporting guidelines in Pennsylvania and surrounding states
- Information about local driver rehabilitation programs
- Standardized driver screening tools
Our team plans to utilize this feedback to inform future quality improvement efforts to improve provider-patient discussions around fitness to drive. We recently finished compiling a fact sheet about local driver rehabilitation programs and hope to begin work on continuing these quality improvement efforts soon.
A Personal Connection
Pursuing this line of research is also personal for me. My grandmother, Rochelle Sobel, founded the Association for Safe International Road Travel (ASIRT) 26 years ago after her son was killed in a bus crash in Turkey, along with 23 other passengers. ASIRT works with government agencies, study abroad programs and corporations to improve global road safety through advocacy and education. The organization was instrumental in the establishment of the US Congressional Caucus on Global Road Safety and is an active participant in World Day of Remembrance events. I have no doubt that my grandmother’s story, and the many childhood summers I spent volunteering with ASIRT, inspired my interest in pursuing this project.
