# Improving the Provision of Postoperative Driving Advice in Discharge Letters After Elective Inguinal Hernia Repair: A Quality Improvement Project

## TL;DR

This study improved the consistency of post-surgery driving advice in discharge letters after hernia repair, enhancing patient and road safety.

## Contribution

A quality improvement project successfully increased adherence to evidence-based driving advice guidelines in clinical practice.

## Key findings

- Correct driving advice in discharge letters increased from 14% to 43% after interventions.
- Clinician understanding of proper driving advice rose from 33% to 90% following targeted education.

## Abstract

Background

Screening of discharge letters after inguinal hernia repair revealed that driving advice following inguinal hernia repair in the University Hospitals of Leicester (UHL) NHS Trust was often inconsistent or absent, which can pose a significant risk to patient safety. When advising patients on driving after groin hernia repair, there are a few factors to be considered, such as including research evidence and medicolegal literature, the development of a transient femoral nerve palsy and stiffness, individual variation postoperatively, and opioid prescription. The aim of this quality improvement project (QIP) was to ensure the provision of consistent, evidence-based postoperative driving advice aligning with the trust and the Royal College of Surgeons of England guidelines to patients following inguinal hernia repair in UHL.

Methodology

A retrospective audit of 42 patients’ discharge letters and the information provided to them by leaflets and verbal methods was conducted in September 2024, followed by a re-audit of 40 patients who had undergone inguinal hernia repair in November 2024. Alongside this, a survey of 50 clinicians was also conducted in September 2024, who work in general surgery, to assess their understanding and distribution of correct driving advice following inguinal hernia repair. This was followed by a survey of 30 clinicians in November 2024 to reassess their knowledge and distribution of driving advice after a teaching session, poster displays, and a reminder email to include driving advice in discharge letters following inguinal hernia repair surgery.

Results

This QIP demonstrated a significant improvement in patients receiving correct driving advice (from 14% to 43%) and in clinician understanding (from 33% to 90%). The first cycle of the QIP showed that 21 (50%) discharge letters did not contain driving advice, and 6 (14.3%) discharge letters contained correct advice. Overall, 10 (43%) of the contactable patients received information leaflets. Further, 11 (48%) of the contactable patients received verbal advice regarding safe driving. Overall, 17 (33%) of the clinicians surveyed reported an understanding of correct recommendations. The second cycle found that only 14 (35%) did not receive driving advice in their discharge letter, and 17 (43%) were given correct advice. Of the contactable patients, 13 (76%) reported being provided a leaflet with the outlined trust driving advice. Moreover, 14 (82%) patients received verbal advice from a healthcare professional. Finally, 27 (90%) of the surveyed clinicians reported understanding the correct advice.

Conclusions

Good targeted education of the residents and consultant clinicians regarding correct driving advice following inguinal hernia repair, as well as visual memory aids in surgical wards, increases the distribution of such advice upon discharge, improving postoperative condition, patient safety, and overall road safety as a result.