Content of safety-netting advice documentation compared with verbalisation for each problema
| Safety-netting advice coding question and codes from observing consultation/medical records | Verbalised SNA (n= 516) | Documented SNA (n= 516) | ||
|---|---|---|---|---|
| n | % | n | % | |
| Presence | ||||
| Present | 242 | 46.9 | 105 | 20.3 |
| Absent | 274 | 53.1 | 411 | 79.7 |
| Problem or treatment safety-netting advice | ||||
| Problem only | 134 | 26.0 | 68 | 13.2 |
| Treatment/management plan only | 18 | 3.5 | 6 | 1.2 |
| Both/mixture | 90 | 17.4 | 31 | 6.0 |
| Format | ||||
| Conditional warning only (for example, ‘worsening advice given’) | 2 | 0.4 | 3 | 0.6 |
| Conditional + course of action (for example, if ‘x happens do y’) | 240 | 46.5 | 102 | 19.8 |
| Number of different symptoms/conditions to look out for | ||||
| 1 | 119 | 23.1 | 76 | 14.7 |
| 2 | 48 | 9.3 | 19 | 3.7 |
| 3 | 32 | 6.2 | 9 | 1.7 |
| 4 | 17 | 3.3 | 1 | 0.2 |
| ≥5 | 23 | 4.5 | 0 | 0.0 |
| Implicit conditional onlyb | 3 | 0.6 | 0 | 0.0 |
| Symptom/condition category present | ||||
| New specific symptom | 82 | 15.9 | 22 | 4.3 |
| Current symptom(s) persists | 98 | 19.0 | 52 | 10.1 |
| Worsening/deterioration | 45 | 8.7 | 18 | 3.5 |
| Otherc | 66 | 12.8 | 9 | 1.7 |
| Problems/issues | 52 | 10.1 | 6 | 1.2 |
| Return of symptoms | 23 | 4.5 | 6 | 1.2 |
| Need/as required (PRN) | 20 | 3.9 | 26 | 5.0 |
| Concerns/worried/struggling | 18 | 3.5 | 4 | 0.8 |
| Changes | 12 | 2.3 | 1 | 0.2 |
| Unwell | 8 | 1.6 | 1 | 0.2 |
| Generic or specific advice | ||||
| Includes specific (for example, cough up blood, chest pain, not better in a set time period) | 135 | 26.2 | 24 | 4.7 |
| All generic (problems, issues, concerns, worse, not better [without time course]) | 107 | 20.7 | 81 | 15.7 |
| Action advised (highest code reported) | ||||
| No action (conditional warning only) | 2 | 0.4 | 3 | 0.6 |
| Contact other in-hours medical service | 5 | 1.0 | 0 | 0.0 |
| Return to practice/same GP | 225 | 43.6 | 100 | 19.4 |
| Contact out-of-hours service | 4 | 0.8 | 0 | 0.0 |
| Contact emergency services (highest code) | 6 | 1.2 | 2 | 0.4 |
| Timescale of action (highest code reported) | ||||
| Not specified | 175 | 33.9 | 72 | 14.0 |
| Named/fixed time (‘2 weeks’) | 48 | 9.3 | 15 | 2.9 |
| Immediate (‘see stat if any change’ – highest code) | 19 | 3.7 | 18 | 3.5 |
↵a Verbalised codes obtained from previous study.14
↵b Example‘So 3 months if not before’.
↵c Other conditions include: develop new ‘symptoms’, ‘want to come back’, ‘not tolerating it’, ‘fed up’, ‘questions’, referral haven’t heard, starts to limit function. Full criteria are listed in the codebook.21 SNA = safety-netting advice.