Driving decisions after critical illness: Qualitative analysis of patient-provider reviews during ICU recovery clinic assessments

Abstract

Background: Driving a vehicle is a functional task requiring a threshold of physical, behavioral and cognitive skills.

Objective: To report patient-provider evaluations of driving status and driving safety assessments after critical illness.

Design: Qualitative secondary analysis of driving-related dialog drawn from a two-arm pilot study evaluating telemedicine delivery of Intensive Care Unit Recovery Clinic assessments. Multidisciplinary providers assessed physical, psychological, and cognitive recovery during one-hour telemedicine ICU-RC assessments. Qualitative secondary analysis of patient-provider dialog specific to driving practices after critical illness.

Setting and patients: Multidisciplinary Intensive Care Unit Recovery clinic assessment dialog between 17 patients and their providers during 3-week and/or 12-week follow-up assessments at a tertiary academic medical center in the Southeastern United States.

Main measures and key results: Thematic content analysis was performed to describe and classify driving safety discussion, driving status and driving practices after critical illness. Driving-related discussions occurred with 15 of 17 participants and were clinician-initiated. When assessed, driving status varied with participants reporting independent decisions to resume driving, delay driving and cease driving after critical illness. Patient-reported driving practices after critical illness included modifications to limit driving to medical appointments, self-assessments of trip durations, and inclusion of care partners as a safety measure for new onset fatigue while driving.

Conclusion: We found that patients are largely self-navigating this stage of recovery, making subjective decisions on driving resumption and overall driving status. These results highlight that driving status changes are an often underrecognized yet salient social cost of critical illness.

Trial registration: Clinicaltrials.gov: NCT03926533.

Keywords: Critical illness; Driving; Driving cessation; Driving resumption; Functional outcomes; Instrumental activities of daily living; Patient-reported outcomes; Qualitative.