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

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.

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.

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!

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

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

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

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. ADI

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

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. STOP DRIVING

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).