The safety netting behaviour of first contact clinicians: a qualitative study

Abstract

BackgroundAcute illness is common in childhood, and it is difficult for healthcare professionals to distinguish seriously ill children from the vast majority with minor or self-limiting illnesses. Safety netting provides parents with advice on when and where to return if their child deteriorates, and it is widely recommended that parents of acutely sick young children should be given safety netting advice. Yet little is known about how and when this is given. We aimed to understand what safety netting advice first contact clinicians give parents of acutely sick young children, how, when, and why.MethodsThis was a qualitative study. Interviews and focus groups were held with doctors and nurses in a general practice surgery, a District General Hospital emergency department, a paediatric emergency department, and an out-of-hours service. Data were analysed using the method of constant comparison.ResultsSixteen clinicians participated. They described that safety netting advice includes advising parents what to look for, when and where to seek help. How safety netting was delivered and whether it was verbal or written was inconsistent, and no participants described being trained in this area. Safety netting appeared to be rarely documented, and was left to individual preference. Limitations of written materials, and structural barriers to the provision of safety netting, were perceived. Participants described that safety netting was influenced by clinicians’ experience, confidence, time and knowledge; and perceived parental anxiety, experience, and competence. Participants noted several limitations to safety netting including not knowing if it has been understood by parents or been effective; parental difficulty interpreting information and desire for face-to-face reassurance; and potential over-reassurance.ConclusionFirst contact clinicians employ a range of safety netting techniques, with inconsistencies within and between organisations. Structural changes, clinician training, and documentation in patient notes may improve safety netting provision. Research is needed into the optimal components of safety netting advice so that clinicians can consistently deliver the most effective advice for parents.

How do general practitioners use ‘safety netting’ in acutely ill children?

“…Recently, Jones et al published a similar study in the UK about the use of 'safety netting' by doctors and nurses (10). As in this study, they conclude that GPs provide patients with 'safety netting' rather intuitively.…”

“…Characteristics of how 'safety netting' is performed in the Jones et al study (10) and ours are largely similar and mentioned in the recommendations for good 'safety netting' according to Almond et al (8). The participating GPs in both studies tailor their advice to the specific context.…”

“…Jones et al report that only one participating GP noted which advice on 'safety netting' he had given (10). In this research, most GPs briefly write down the given advice in the medical record that was also stressed by Almond et al (8).…”

“…There seems to be no agreement considering the format of delivery amongst the participating GPs in the research by Jones et al (10), or amongst the doctors that took part in the modified Delphi procedure of Almond et al (8).…”

“…The only other explorative study on 'safety netting' behaviour of first contact clinicians was recently conducted by the 'ASK SNIFF' (acutely sick kids, safety netting interventions for families) research team. They noticed a range of 'safety netting' techniques with many inconsistencies, concerning their relative effectiveness on a variety of outcomes such as referrals, admission rates, re-attendance to healthcare and parental understanding, anxiety and satisfaction (10,11).…”