Safety-netting communication during telephone consultations: an observational study using recorded consultations.

Abstract (English)

BACKGROUND: In 2024, one-third of NHS GP consultations in England were conducted by telephone. Although remote consulting can be convenient for patients and GPs, it may increase diagnostic uncertainty. Safety-netting advice (guidance on when, and how, patients should seek further medical help) is a tool used to mitigate clinical risk, but its delivery during telephone consultations has not been studied in detail. AIM: To evaluate the communication, documentation, and patient recall of safety-netting advice in GP telephone consultations. DESIGN & SETTING: Observational study using data from seven GP practices in south west England. METHOD: Practices routinely recording telephone consultations were invited to participate. Patients with a recent telephone consultation with a participating clinician were invited to consent to consultation recording retrieval, medical record extraction, and completion of a post-consultation questionnaire. Recordings of 96 telephone consultations were obtained and coded using the validated Safety-Netting Coding Tool. Regression models explored factors associated with safety-netting advice. Patient recall was assessed using post-consultation questionnaires. RESULTS: There were 93 instances of safety-netting advice, delivered in 60.4% (<i>n</i> = 58) of 96 consultations applying to 43.4% (<i>n</i> = 72) of 166 identified problems. Instances of safety-netting advice were mostly GP initiated (95.7%, <i>n</i> = 89), delivered during treatment planning (66.7%, <i>n</i> = 62), and included specific elements (64.5%, <i>n</i> = 60). Delivered safety-netting advice was documented in 64.2% (<i>n</i> = 34) of 53 consultations with notes that were available. Written advice was rarely used: only four out of 96 consultations contained written advice, which was delivered via text message. Patients correctly recalled the presence of safety-netting advice in two-thirds of consultations when it was given. Safety-netting advice was more likely to be provided by younger GPs (aged <45 years; odds ratio 5.09, <i>P</i> = 0.011). CONCLUSION: Safety-netting advice was commonly delivered during GP telephone consultations, but its delivery, documentation, and recall were inconsistent. Opportunities exist to improve the consistency, documentation, and use of written advice to support patient understanding, recall, and safety in remote care.