Safety-netting in the consultation
BMJ 2022; 378 doi: https://doi.org/10.1136/bmj-2021-069094 (Published 25 July 2022) Cite this as: BMJ 2022;378:e069094
- Peter J Edwards, GP academic clinical fellow ST41,
- Paul Silverston, visiting professor2,
- Jane Sprackman, patient advisor3,
- Damian Roland, children’s emergency medicine consultant and honorary professor of paediatric emergency medicine4 5
- 1Centre for Academic Primary Care, University of Bristol, Bristol BS8 2PS, UK
- 2Anglia Ruskin University, Cambridge, and University of Suffolk, Ipswich, UK
- 3Bristol, UK
- 4SAPPHIRE Group, Health Sciences, Leicester University, Leicester, UK
- 5Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, UK
- Correspondence to: P J Edwards peter.edwards{at}bristol.ac.uk
What you need to know
Aggressively treating or investigating all patients with early undifferentiated illness is poor medical practice and can be harmful
Time is an important diagnostic tool but creates a period of uncertainty and risk for patients with serious underlying conditions
Safety-netting can help mitigate this risk, and the traffic light framework provides a structure for delivering safety-netting advice
Safety-netting has become a widely used term to describe an array of activities both within the consultation and on systems levels. Within the consultation, safety-netting is considered best practice, and often an expected clinical standard, particularly in primary and emergency care.12 The term was first coined by Roger Neighbour in 1987 as an in-consultation tool for managing clinical uncertainty.3 Safety-netting advice has since been defined as: “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.”45 This article outlines the principles and evidence base (box 1) of safety-netting and offers an approach to giving effective safety-netting advice.
Is there an evidence base for safety-netting?
A literature review in 2019 reported the most common type of safety-netting article was an expert opinion (n=25), followed by qualitative studies (n=12), with no completed randomised controlled trial (RCT).6 An updated realist review in 2022, which produced 15 recommendations to enhance the communication of safety-netting advice, included reference to two randomised trials, but neither had a primary intervention of safety-netting or referred to this term.7
However, there have been multiple RCTs of treating common infections with arms comparing patient information leaflets (which commonly contain safety-netting advice) against no leaflets. In a systematic review of such studies, six of the seven RCT leaflets included safety-netting advice (one was unclear), which demonstrated an overall trend towards …
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