Embedding Postoperative Driving Advice Into Electronic Discharge Documentation After Elective Joint Replacement: A Closed-Loop Quality Improvement Project

Background and objectives Return to driving is an important consideration following joint replacement, with implications for patient safety, independence, and medico-legal responsibility. However, the consistency with which postoperative driving, Driver and Vehicle Licensing Agency (DVLA), and insurance advice is communicated, documented, and understood is unclear. This study evaluated the documentation and provision of postoperative driving, DVLA, and insurance advice following elective joint replacement, alongside patients' awareness and junior doctors' knowledge and confidence. The primary aim was to assess and improve the documentation of postoperative driving advice following elective total hip replacement (THR), total knee replacement (TKR), or total shoulder replacement (TSR). Secondary aims were to assess patient awareness of DVLA requirements and to explore junior doctors' knowledge and confidence in providing postoperative driving, DVLA, and insurance advice. Methods A two-cycle, closed-loop quality improvement project was undertaken within the orthopaedic department at a tertiary teaching hospital. Baseline discharge documentation was reviewed for patients who underwent elective THR, TKR, or TSR between December 2025 and February 2026. Eligible patients were surveyed regarding receipt of postoperative driving advice and awareness of DVLA requirements. Junior doctors within the department completed a structured questionnaire assessing their knowledge and confidence in providing advice. A guideline-informed driving, DVLA, and insurance advice section was subsequently embedded within the discharge-summary template. A re-audit was undertaken in patients who underwent elective arthroplasty between March and April 2026, with repeat assessment of discharge documentation, eligible patient surveys, and junior doctor surveys in a new cohort of patients and junior doctors. Results Driving advice was documented in 0/101 baseline discharge summaries versus 63/78 (80.8%) post-intervention, an absolute increase of 80.8 percentage points (95% confidence interval (CI): 70.0-88.0; p < 0.001). Advice meeting predefined content criteria was documented in 62/78 (79.5%) post-intervention summaries vs. 0/101 at baseline (absolute increase 79.5 percentage points, 95% CI: 68.6-87.0; p < 0.001). The composite of documented or patient-reported advice increased from 30/63 (47.6%) to 32/34 (94.1%; p < 0.001). DVLA awareness was recorded for 15/61 (24.6%) baseline and 15/34 (44.1%) post-intervention respondents; evidence of a change was inconclusive (p = 0.066). Clinician findings were descriptive. The designated DVLA/insurance response was selected by 3/6 (50%) baseline and 4/6 (67%) post-intervention junior doctors, while mean confidence scores increased from 2.67 to 3.33 out of 5. Conclusions Embedding guideline-informed postoperative driving, DVLA and insurance advice within the electronic discharge template was associated with increased documentation of driving advice meeting predefined content criteria and a higher composite of documented or patient-reported advice. The intervention was simple and required no additional educational programme; it was designed to reduce reliance on individual clinician memory. Changes in patient DVLA notification awareness were inconclusive, and clinician findings were exploratory. Documentation did not establish patient receipt or comprehension. Sustainability beyond the two-month follow-up requires evaluation.