Abstract
BackgroundSafety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health.AimTo assess when and how safety-netting advice is delivered in routine GP consultations.Design and settingThis was an observational study using 318 recorded GP consultations with adult patients in the UK.MethodA safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables.ResultsA total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems.ConclusionGPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient’s part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.
Highlights
The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP
Safety netting is a key element of the Royal College of General Practitioners (RCGP) curriculum, features in multiple consultation models and clinical guidelines, and is recognised as forming part of ‘best practice’ in primary care.[3,8,9,10,11,12,13,14]
A lack of safety netting has been implicated in contributing towards harm to patients, and GPs have been criticised for its omission.[15,16]
Summary
Safety netting is a diagnostic strategy, utilised to manage clinical uncertainty, highlight ‘red flags’, and help monitor patients until their symptoms are explained.[1,2] This broad term has been used to describe advice given during healthcare encounters, and system and administration factors.[1,3,4] This study assessed the communication of ‘safety-netting advice’, defined as: ‘Information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health’,5 which was adapted from Roland and colleagues’ definition.[6]Recommendations to incorporate safety netting into everyday clinical practice are widespread.[3,7] Safety netting is a key element of the Royal College of General Practitioners (RCGP) curriculum, features in multiple consultation models and clinical guidelines, and is recognised as forming part of ‘best practice’ in primary care.[3,8,9,10,11,12,13,14] a lack of safety netting has been implicated in contributing towards harm to patients, and GPs have been criticised for its omission.[15,16]. Safety netting is a diagnostic strategy, utilised to manage clinical uncertainty, highlight ‘red flags’, and help monitor patients until their symptoms are explained.[1,2] This broad term has been used to describe advice given during healthcare encounters, and system and administration factors.[1,3,4] This study assessed the communication of ‘safety-netting advice’, defined as: ‘Information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health’,5 which was adapted from Roland and colleagues’ definition.[6]. Safety-netting advice is information shared with a patient or their carer designed to help them identify the need to seek further medical help if their condition fails to improve, changes, or if they have concerns about their health
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