Safety-netting advice documentation in out-of-hours primary care: a retrospective cohort from 2013 to 2020

Background Providing safety-netting advice (SNA) in out-of-hours (OOH) primary care is a recognised standard of safe care, but it is not known how frequently this occurs in practice. Aim Assess the frequency and type of SNA documented in OOH primary care and explore factors associated with its presence. Design and setting This was a retrospective cohort study using the Birmingham Out-of-hours general practice Research Database. Method A stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression. Results The overall frequency of SNA per consultation was 78.0% (1472/1886), increasing from 75.7% (224/296) in 2014 to 81.5% (220/270) in 2019. The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients’ condition worsened followed by if their symptoms persisted, but only one in five consultations included a timeframe to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared with telephone consultations (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.09 to 2.85, P = 0.02), for possible infections (OR 1.53, 95% CI = 1.13 to 2.07, P = 0.006), and less frequently for mental (versus physical) health consultations (OR 0.33, 95% CI = 0.17 to 0.66, P = 0.002) and where follow-up was planned (OR 0.34, 95% CI = 0.25 to 0.46, P<0.001). Conclusion The frequency of SNA documented in OOH primary care was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however, this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations.