Safety netting for primary care: evidence from a literature review.

BACKGROUND: Ensuring patient safety is vital in primary care. One mechanism to increase patient safety is through a practice known as safety netting. Safety netting is widely recommended in national guidelines; however, a variety of definitions exist with no consensus on when safety netting should be used and what advice or actions it should contain. AIM: This study aimed to identify different definitions of safety netting to provide conceptual clarity and propose a common approach to safety netting in primary care. DESIGN AND SETTING: Literature review and evidence synthesis of international articles relating to safety netting in primary care. METHOD: An electronic database and grey-literature search was conducted using terms around the theme of safety netting with broad inclusion criteria. RESULTS: A total of 47 studies were included in the review. Safety netting was defined as a consultation technique to communicate uncertainty, provide patient information on red-flag symptoms, and plan for future appointments to ensure timely re-assessment of a patient's condition. Safety-netting advice may include information on the natural history of the illness, advice on worrying symptoms to look out for, and specific information on how and when to seek help. In addition to advice within the consultation, safety netting includes follow-up of investigations and hospital referrals. Safety netting was considered to be particularly important when consulting with children, the acutely unwell, patients with multimorbidity, and those with mental health problems. CONCLUSION: Safety netting is more than solely the communication of uncertainty within a consultation. It should include plans for follow-up as well as important administrative aspects, such as the communication of test results and management of hospital letters.