Safety-NETting for Timely Diagnosis (NETTD) in Primary Care

The NETTD study produced an evidence-based theory of how safety-netting advice is effectively communicated and 15 recommendations for how clinicians can incorporate effective safety-netting into their consultations. These recommendations are based on our findings that effective safety-netting communication depends on the clinician understanding the information needs of the patient, any barriers that might prevent them from being able to follow the advice, and the patient understanding why the safety-netting advice is being given.

Safety-netting is the advice that GPs and other clinical staff give to patients when there is uncertainty in what might be causing their symptoms or how their illness might progress. It can include advice on how the patient can care for themselves, where to go for more help if it is needed, and tasks for the GP to do to make sure that they follow-up with the patient. Safety-netting aims to make sure that if a patient’s symptoms are caused by something serious, or if their illness worsens they are given further tests or treatments with minimal delay. Safety-netting happens in a large proportion of the consultations that take place every day and so it impacts the care of many patients. Poor safety-netting, however, can cause diagnostic error, and contribute to unnecessary re-consultations and delayed diagnosis. Despite this there is little guidance on how it should be delivered, recorded, and followed-up.

We conducted a realist review of the published research to answer the question How, why, for whom, in what contexts, is safety-netting used appropriately? To do this we searched for research that described the factors that contributed to the effective communication of health information. We worked with a panel of public and professional representatives to build a theory of how safety-netting should be communicated so that it can achieve its aims of supporting patients to self-care when they can and also return for more medical advice when it is needed.

AIMS

What is already known on the topic?

Safety-netting is a part of everyday practice in primary care and is used to deal with diagnostic uncertainty, and to support patients to manage their symptoms when appropriate and reconsult when necessary. Its use, however, is highly varied and a lack of evidence-based guidance on its communication could be harming its effectiveness and putting patient safety at risk.

What this study adds?

This study presents an evidence-based theory of and recommendations for how effective safety-netting might be achieved.

How might this study affect research, practice or policy?

Effective safety-netting relies on general practitioner–patient understanding that should be built throughout the consultation and as such it should be incorporated into the whole of the consultation.

HOW ARE WE INVOLVING PATIENTS AND PUBLIC

We had a panel of five members of the public who were involved all through the project. We met every few months through the project to update them on our progress and discuss what we had found in the published research and how we would use it. They contributed to the interpretation of our findings and the creation of our theory of safety-netting.