Safety-netting in primary care consultations
An Investigation of GP Safety-Netting Practices in Primary Care Consultations
University of Bristol
Duration of Study in the UK
0 years, 11 months, 2 days
Safety-netting is information given to a patient or their carer during a primary care consultation, about actions to take if their condition fails to improve, changes or if they have further concerns about their health in the future. An example of a safety-netting statement would be “please make another appointment if your symptoms do not improve”. There is currently no set gold standard of what form safety-netting advice should take or how it should be delivered.
The proposed study will examine safety-netting practices in primary care using data already collected during the ‘Bristol Archive Project’ (REC 14/SW/0112) - an archive of video-recorded consultations plus linked data. Data linked to these consultations include: patient and GP questionnaires and related primary care medical records. 327 GP consultations, with 23 GPs, from 12 practices in the South-West were recorded between July 2014 to April 2015. 300 patients consented for the data to be used by other researchers, subject to further ethical approval. This database is securely archived in the Bristol University Research Data Repository.
We aim to use this database to identify a sample of consultations where safety-netting techniques are utilised. We will then use a new coding scheme to analyse when, and how, safety-netting information is delivered in primary care consultations. Specifically, who introduces the topic of safety-netting; where this is done in the consultation; what information is delivered and how it is delivered; how patients respond; and how safety-netting advice is documented in medical records. In addition, we aim to explore linked data to ascertain: whether any patient, GP or practice characteristics, or particular health problems are associated with different levels of safety-netting.
Summary of Results
In this study, researchers looked at a selection of just over 300 GP-patient video/audio recorded consultations involving 23 different GPs. Researchers watched for the presence or absence of ‘safety-netting advice’, which 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’.
For example, a doctor might say “if your cough is no better in 3 weeks or you start coughing up blood you need to come back for another assessment”.
Researchers found that safety-netting advice was present in approximately two-thirds of consultations and some GPs almost always gave safety-netting advice whereas others very rarely did. The younger GPs (aged less than 50 compared to 50 and over) gave more safety-netting advice than the more senior GPs. Doctors were also more likely to give safety-netting advice for problems assessed first in the consultation (as patients often came with more than one problem to the consultation) and for problems where the patient’s symptoms had recently started compared to symptoms that had been there for a long time.
Approximately half of the time doctors gave specific advice such as “if it doesn’t get better in 2 weeks let me know”, but the other half of the time doctors only gave generic advice such as “if it doesn’t get better let me know”.
Researchers also compared what GPs said in the consultation to what the doctor wrote down in the patients’ medical notes. More than half of the time, the doctors did not record their safety-netting advice in the patients’ medical records. GPs more often wrote down their advice if they had given specific advice to the patient or if the patient had come with a new problem.
In consultations where the doctor and the patient discussed more than one problem, the later a problem was discussed, the less likely the doctor was to give safety-netting advice or record safety-netting advice in the patients’ medical records. Safety-netting is important part of patient care and this might indicate that trying to squeeze too many different problems into one consultation might mean important discussions such as safety-netting are missed out.
London - Brent Research Ethics Committee
Date of REC Opinion
14 Sep 2016