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


METHODS
This 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.


RESULTS
Sixteen 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.


CONCLUSIONS
First 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.
Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, OX2 6GG Oxford, England. caroline.jones@phc.ox.ac.uk.
Caroline H D
CH
Jones
Sarah
S
Neill
Monica
M
Lakhanpaul
Damian
D
Roland
Hayley
H
Singlehurst-Mooney
Matthew
M
Thompson
D000208:Acute Disease; D000328:Adult; D039602:After-Hours Care; D002648:Child; D004636:Emergency Service, Hospital; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010290:Parents / Q000193:education*; D010353:Patient Education as Topic; D010371:Pediatric Nursing / Q000379:methods*; D010372:Pediatrics / Q000379:methods*; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research