Journal article on safety netting

Safety Netting in Healthcare: Components and Recommendations

• Safety netting is recommended at every healthcare professional-patient contact, especially in acute settings like ED and OOH centers.
• Two-thirds of the reviewed articles (n = 38) provided suggestions for safety-netting advice components.
• The most recommended components of safety-netting advice were communicating uncertainty, advice on worrying symptoms and red flags, likely time course of illness, seeking further medical care, arranging planned follow-up, primary care investigations, and organizational components.
• Planned follow-up is a distinct element of safety netting, involving a review in a similar setting, often with the same healthcare professional.
• Safety netting around investigations includes explaining the purpose of tests, how they are undertaken, and ensuring patients can follow up on their results.
• Organizational components of safety netting include documenting advice in patient's notes, ensuring abnormal results are dealt with, and updating patients' contact details.
• Written safety-netting instructions and careful documentation in the medical notes are recommended by several articles.
• Safety netting has been described as an essential component of the consultation since 1987 and is advocated by national guidelines.
• Despite variations in settings and patient groups, the definitions and component parts of safety netting seem to be largely universal.
• Safety netting includes managing uncertainty, advice on red-flag symptoms, likely time course of the illness, accessing further medical care, follow-up, and managing investigations.
• The most recognizable part of safety netting is managing uncertainty, which may now include prognostic and management uncertainty.
• Funding for the review was provided by the National Institute for Health Research (NIHR) Academic Clinical Fellowship (ACF), and no specific funding was attached to the review. Ethical approval was not required.

Defining and Implementing Safety Netting in Primary Care

• Safety netting is part of Neighbour's consultation model and the Calgary-Cambridge model, included in the section "closing the session".
• Bankhead et al were among the first to provide recommendations for safety netting in primary care, focusing on the components related to cancer diagnosis and suggesting it may be more than a consultation technique.
• The review aimed to collate evidence on safety netting for all patients, including defining safety netting, when it is required, and the information it should contain.
• The literature review focused on exploring varying definitions and content of safety netting, using a narrative synthesis approach and the ENTREQ checklist for reporting qualitative research synthesis.
• Safety netting is widely recommended in national guidelines, but there is no consensus on when it should be used and what advice or actions it should contain.
• The review included 47 studies and defined safety netting as a consultation technique to communicate uncertainty and provide patient information on red-flag symptoms, with plans for timely re-assessment and follow-up of investigations and hospital referrals.
• Safety netting advice may include information on the natural history of the illness, advice on worrying symptoms, and specific information on seeking help, particularly important for children, the acutely unwell, patients with multimorbidity, and those with mental health problems.
• Safety netting is more than the communication of uncertainty within a consultation; it should include plans for follow-up and administrative aspects such as communication of test results and management of hospital letters.
• The concept of safety netting is relatively imprecise and can be used in different patient groups and settings, with different actions.
• The literature review used broad inclusion criteria, focusing on patients, carers, or healthcare professionals, and included English-language articles using any research design.
• The review aimed to provide conceptual clarity and propose a common approach to safety netting in primary care, emphasizing its importance as best practice for patient safety.
• The study conducted an extensive electronic database and grey-literature search, using search terms around the theme of safety netting and including citation searches of all included articles.