Do Emergency Physicians Educate Patients about the Dangers of Drinking and Driving after a Motor Vehicle Collision, and What Are the Barriers or Motivators to Do So?.

ABSTRACT Introduction: Impaired driving is the leading cause of criminal death in Canada and results in numerous emergency department (ED) visits each year. Methods: An online survey was distributed to 94 emergency physicians and emergency medicine residents at an academic tertiary care hospital in Southwestern Ontario. Descriptive statistics were calculated. Results: We received 76 responses (81% response rate). Physicians widely varied in the frequency with which they discussed the dangers of drinking and driving with patients. Only 13% had consulted the ED social worker and 32%> had used an alcohol screening questionnaire in the past 12 months. The greatest barriers to addressing drinking and driving with motor vehicle collision (MVC) patients were severity of injury, lack of time and intoxication. The great motivators were a sense of personal responsibility, concern for patients ' health and safety and having the time. Conclusion: The information from this survey brings awareness to the longstanding problem of drinking and driving, explores the barriers and motivators to addressing this topic in the ED, and can be used to develop new strategies to educate trauma patients on the dangers of impaired driving. INTRODUCTION Impaired driving is the leading cause of criminal death in Canada (Stats Can 2011) and results in thousands of emergency department (ED) visits each year. Over 700 Canadians are killed by a drinking driver each year, and nearly 28% of all road traffic fatalities involve alcohol. (Vanlaar, Robertson, Marcoux, et al, 2012) In Ontario alone, more than 5,000 crashes resulted in personal injury or property damage after drivers had consumed alcohol in 2012. (Ontario Road Safety annual Report, 2012) Impaired driving leading to death, injury and property damage costs Canadians $20 billion dollars annually. (Pitel, Soloman, 2010) Physician advice has been well-demonstrated to have a positive effect on health behaviours. A 2013 Cochrane review on smoking cessation found that brief physician advice doubled the quit rate from an unassisted quit rate of 2 to 3% by an additional 1 to 3%. (Stead, Buitrago, Preciado, et al, 2013) In relation to alcohol consumption, brief motivational interviewing (BMI) has been shown to delay impaired driving and other dangerous traffic violations in young recidivists. (Ouimet, Dongier, Di Leo, et al, 2013) Evidence exists for the use of BMI for alcohol in both primary care (Nilssen, 2004; Kaner, et al, 2007; Solberg, et al, 2008) and inpatient trauma settings (Gentilello, Ebel, Wickizer, et al, 2005) to effectively reduce alcohol consumption and injury recurrence. (Gentilello, Rivara, Donovan, et al, 1999) Emergency physicians have a unique opportunity to educate patients on health behaviours after life-threatening events, when they are more receptive to advice and ready to change. Emergency department based brief interventions to reduce risky driving and hazardous drinking have demonstrated effectiveness. (Sommers, Lyons, Fargo, et al, 2013) In a study by Harrison et al., trauma patients who had exceeded drinking limits were more likely than other ED patients to have a strong desire to cut back on alcohol consumption in order to avoid situations where they could get hurt and to be more in control of their behaviour. (Harrison, Hoonpongsimanont, Anderson, et al, 2014) This, in combination with emergency physician support for a brief ED intervention (Graham, Maio, Blow, et al, 2000), suggests doctors could be doing more to capitalize on a teachable moment in the ED. We sought to describe our hospital practice as it pertains to educating alcohol-impaired drivers in the ED, in order to identify areas for improvement, as well as barriers and motivators for brief alcohol interventions by emergency physicians. METHODS An online survey was developed and pre-tested with surgical residents, and then distributed to all 63 adult emergency physicians and 31 emergency medicine residents at London Health Sciences Centre (LHSC). …

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