Driving Assessment – The Decision Making Process in Scotland

1. Driving Assessment – The Decision Making Process in Scotland Lynne Hutton Scottish Driving Assessment Service

2. What • Identify the decision making steps that are undertaken by the assessor during a driving assessment. • Develop clinical algorithm detailing each step and potential outcome for individual patient.

3. Why? • Facilitate consistency of decision making between assessors. • Ensure consistent advice provided to patients post driving assessment. • Enable new staff members to identify key areas within assessment process. • Allow outside agencies to understand some of complexities of driving assessment.

4. Caution • Does not identify how you reach individual decisions in each sub-section of assessment. • Does not allow untrained person to undertake driving assessment. • One algorithm will never meet all patients idiosyncrasies!

5. Licence Check Medical Fitness Eyesight (Acuity/Fields/ Inattention) Referral Screened ASSESSMENT Physical Examination Test Rig Cognitive Function STOP DRIVING In-Car Assessment

6. In-Car Assessment Standard Controls Standard Controls Adaptations Required Scores 1 & 2 Scores 3 ↓ learning or Progressive condition Scores 3 ↓ Learning ability Scores 4 Scores 3 Non – progressive condition Scores 1 & 2 Part Route Scores 3 Non – Progressive Condition Scores 4 Scores 1 & 2 Full route REVIEW STOP DRIVING ADI DRIVE

7. DRIVE • Inform DVLA and insurance company of diagnosis and adaptations if required.

8. ADI • Inform DVLA/Insurance company of diagnosis/adaptations if required. • If DVLA referral await decision regarding licensing. • Obtain ADI report then decide if clinical review required. • Limit number of lessons +/- review.

9. REVIEW • Inform DVLA/insurance company of diagnosis and adaptations. • Do not drive until seen at centre for review.

10. STOP DRIVING • Inform DVLA of diagnosis/advice. • Ask GP to re-refer at appropriate point. • Acuity – optician review, then SDAS review if corrected. • Fields – binocular Esterman test – results to DVLA if dubious/fail. • If no licence discuss reapplication to DVLA if appropriate. • If not suitable then advice return licence to DVLA.

11. Conclusion • Decision making in driving assessment occurs at numerous points throughout the individual assessment . • Decision making points can be documented on algorithm as above. • Algorithm may be useful both within service (for consistency and training) and to outside agencies (to understand complexity of final assessment conclusion).