Title : QIP driving advice in stroke patients
Abstract:
Verbal and written reminders to clinicians are a recognised but limited quality-improvement lever. We tested whether redesigning the electronic patient record itself, rather than educating the clinicians who use it, could achieve reliable adherence to DVLA driving guidance in stroke and TIA patients. Baseline audit (Cycle 1, n=85, 59 confirmed stroke) found 58% of eligible patients lacked documented driving advice at discharge. An awareness campaign (Cycle 2: posters, circulated guidance, team discussion; n=70, 53 confirmed stroke) improved documentation to approximately 60% in-patient and 56.6% at discharge, but adherence remained inconsistent and dependent on which clinician conducted the discharge interview.
We therefore worked with the Digital/IT team to redesign the stroke pathway within the electronic patient record (Qmed): a mandatory field now prompts documentation of driving status during the initial history and discharge interview, and, where the patient is identified as a driver, the relevant DVLA advice is automatically inserted into the discharge letter. Re-audit (Cycle 3, n=56, 26 confirmed stroke) showed 100% adherence (21/21) among confirmed stroke drivers for both in-patient and discharge-letter advice — a complete resolution of the original gap.
This project illustrates a broader principle for rehabilitation and stroke services: technology-embedded prompts can convert an unreliable, memory-dependent task into a guaranteed one, at negligible recurring cost and without adding to clinical workload. Because the intervention lives in the record rather than in individual practice, it is inherently resistant to staff turnover — a persistent vulnerability in rotational training posts. We propose this EPR-embedding approach as a scalable model for other statutory or high-risk discharge-advice requirements across rehabilitation settings.
