Background 3.5 million people in the UK have excessive daytime sleepiness and 1 in 5 Road Traffic Accidents are due to sleepiness while driving.
Aim To improve Patient and Public safety by auditing whether DVLA’s driving safety advice is given to patients with excessive daytime sleepiness in two settings: (i) at referral as recommended by The Royal Society for the Prevention of Accidents guidelines and (ii) at the Regional Sleep Clinic as recommended by the BTS guidelines.
Method Retrospective study between 01/10/15 and 06/01/16 of (i) 100 referral letters to the Regional Sleep Clinic and (ii) 100 sleep clinic letters to patients’ GP. In both cases, patients were included if the letter mentioned ‘Daytime sleepiness’ or if their Epworth Sleepiness Score (ESS) was over 10 (indicating excessive daytime sleepiness).
Results Only 19% of referral letters from primary and secondary care had documented giving driving safety advice to patients with daytime sleepiness. Sixteen specialties referred patients to the Sleep clinic. General Practice accounted for three quarters of these referrals and driving safety had only been discussed in 14% of cases. Even with specialties like Respiratory medicine and Neurology which see patients with sleep disorders regularly, very few had discussed driving safety.
The Sleep Clinic gave DVLA advice to 85% of patients. In the 15% where no advice was given, patients usually had ESS <10 (but symptomatically sleepy) or sleepiness as a secondary consequence of insomnia/non-REM parasomnia.
7 patients reported falling asleep while driving (only 2/7 were discovered at referral). Moreover, the Sleep Clinic noted that 1 had a Road Traffic Accident and 1 had a near miss. Average waiting time from referral to Sleep Clinic appointment was 3 months. Thus driving advice needs to be given at referral.
A limitation of this audit is that not all clinicians record discussions about driving even though it is important for medicolegal purposes.
Conclusion Driving safety discussions on referral can be improved by educating GPs/secondary care and introducing an Alert on eReferral. The Sleep Clinic should use a pro forma to remind clinicians to discuss driving regardless of a patient’s ESS or diagnosis.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.