Abstracts

Rationale: Approximately 40,000 drivers have fatal crashes every year. Risk of fatal crashes is 2-4 times higher in epileptics than patients with other diseases. California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania require physicians to report patients who have seizures to the department of motor vehicles. Arizona is not a reporting state. Failure to document instructions regarding legal driving restrictions may leave physicians vulnerable to legal liability. As a systems-based practice project, we evaluated the quality of documentation that patients were counseled about driving restrictions and safety precautions following emergency room visits for episodes of altered level of consciousness and seizures. Methods: A retrospective chart review was conducted of patients with all diagnostic codes of epilepsy, transient altered consciousness, syncope and collapse, other convulsions, and altered mental status at the Mayo Clinic Arizona emergency department, during 2006. Presence or absence of documented counseling regarding driving and safety precautions was noted.Results: 340 patients with episodes that would require driving counseling were found. There were 140 males and 200 females. The age ranged between 2-100 years. Ninety seven patients had a seizure or convulsion diagnosis, and 243 had syncope or alteration in level of consciousness. The overall number of patients with documented counseling about driving laws and safety precautions was surprisingly low at 17 (5.00%). Age range of patients that were counseled is between 23-87 years. Twelve of 17 that were counseled regarding driving had diagnostic code of other convulsions. Three had episodes of alteration in consciousness. One patient had a focal epileptic event and one had new onset grand mal seizureConclusions: Counseling regarding driving laws and safety precautions for common diagnoses of seizures and episodes of alteration of consciousness are not being adequately documented by ER physicians. This finding has potential legal implications for practicing physicians. In an effort to improve the medical record, we suggest a system based practice modification in our emergency department by adding a checklist to include counseling regarding driving and safety precautions.