Safety netting for bronchiolitis

BackgroundChildren’s use of urgent care services continues to increase. If families are to access the right services at the right time they need access to information to inform their decision making. Providing a safety net of information has the potential to reduce morbidity and avoidable mortality and has been shown to reduce re-consultation safely.AimOur research programme aims to provide parents with information they can use to help them determine when to seek help for an acutely ill child.MethodOur programme includes: ASK SARA, a systematic review of existing interventions; ASK PIP, qualitative exploration of safety netting information used by parents and professionals; ASK SID, development of the content and delivery modes for the intervention; ASK ViC, video capture of children with acute illness; and ASK Petra, safety netting tool development using consensus methodology.ResultsThe ASK SNIFF programme findings demonstrate the need for professionally endorsed and co-produced safety netting resources focussing on symptoms of acute childhood illness. We now have consensus on the scripted content for a safety netting tool supported by video materials to enable parents to see symptoms for real.ConclusionSafety netting tools are a valuable aid to general practice enabling GPs to show parents what to look out for when their child is sick so that they know when to (re)consult. Recent reports of failure to recognise and appropriately safety net children with sepsis highlights the importance of such tools.

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Lockdown dilemma: ingestion of magnetic beads presenting as right iliac fossa pain and subacute small bowel obstruction

BMJ Case Reports ◽

10.1136/bcr-2020-236429 ◽

2020 ◽

Vol 13 (11) ◽

pp. e236429

Author(s):

Bankole Oyewole ◽

Anu Sandhya ◽

Ian Maheswaran ◽

Timothy Campbell-Smith

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Magnetic Beads ◽

Iliac Fossa ◽

Serous Fluid ◽

Magnetic Resonance Scan ◽

History Of ◽

Right Iliac Fossa Pain ◽

Multiple Episodes ◽

Safety Netting

A 13-year-old girl presented with a 3-day history of migratory right iliac fossa pain. Observations and inflammatory markers were normal, and an ultrasound scan was inconclusive. A provisional diagnosis of non-specific abdominal pain or early appendicitis was made, and she was discharged with safety netting advice. She presented again 6 days later with ongoing abdominal pain now associated with multiple episodes of vomiting; hence, the decision was made to proceed to diagnostic laparoscopy rather than a magnetic resonance scan for further assessment. Intraoperative findings revealed 200 mL of serous fluid in the pelvis, normal-looking appendix, dilated stomach and a tangle of small bowel loops. Blunt and careful dissection revealed fistulous tracts that magnetised the laparoscopic instruments. A minilaparotomy was performed with the extraction of 14 magnetic beads and the repair of nine enterotomies. This case highlights the importance of careful history taking in children presenting with acute abdominal pain of doubtful aetiology.

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Parent and Clinician Views of Managing Children with Symptoms of a Lower Respiratory Tract Infection and Their Influence upon Decisions to Take Part in a Placebo-Controlled Randomised Control Trial

Antibiotics ◽

10.3390/antibiotics10040356 ◽

2021 ◽

Vol 10 (4) ◽

pp. 356

Author(s):

Catherine J. Woods ◽

Zoe Morrice ◽

Nick A. Francis ◽

Paul Little ◽

Theo Verheij ◽

...

Keyword(s):

Respiratory Tract ◽

Lower Respiratory Tract ◽

Controlled Trial ◽

Randomised Control Trial ◽

Antibiotic Prescribing ◽

Parent Attitudes ◽

Telephone Interviews ◽

Tract Infections ◽

Interview Studies ◽

Safety Netting

Children presenting with uncomplicated lower respiratory tract infections (LRTIs) commonly receive antibiotics despite public campaigns on antibiotic resistance. Qualitative interview studies were nested in a placebo-controlled trial of amoxicillin for LRTI in children. Thirty semi-structured telephone interviews were conducted with sixteen parents and fourteen clinicians to explore views of management and decisions to participate in the trial. All interviews were audio-recorded, transcribed and analysed using thematic analysis. Parents found it difficult to interpret symptoms and signs, and commonly used the type of cough (based on sound) to judge severity, highlighting the importance of better information to support parents. Provision of a clinical examination and reassurance regarding illness severity were key motivations for consulting. Many parents now acknowledge that antibiotics should only be used when ‘necessary’, and clinicians reported noticing a shift in parent attitudes with less demand for antibiotics and greater satisfaction with clinical assessment, reassurance and advice. Decisions to take part in the trial were influenced by the perceived risks associated with allocation to a placebo, and concerns about unnecessary use of antibiotics. Clear communication about self-management and safety-netting were identified as important when implementing ‘no antibiotic’ prescribing strategies to reassure parents and to support prescribing decisions.

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

BMC Family Practice ◽

10.1186/1471-2296-14-140 ◽

2013 ◽

Vol 14 (1) ◽

Cited By ~ 21

Author(s):

Caroline HD Jones ◽

Sarah Neill ◽

Monica Lakhanpaul ◽

Damian Roland ◽

Hayley Singlehurst-Mooney ◽

...

Keyword(s):

Qualitative Study ◽

First Contact ◽

Safety Netting

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My prison experience

The British Journal of Psychiatry ◽

10.1192/bjp.195.2.141 ◽

2009 ◽

Vol 195 (2) ◽

pp. 141-141

Author(s):

Bernice Knight

Keyword(s):

Mental Illness ◽

Medical Student ◽

Inner City ◽

Mass Incarceration ◽

Safety Netting

Visiting an inner-city prison as a medical student, I was unsure how I would respond to this mass incarceration of life. The anxiety manifesting in my stomach as I passed through the entrance gate, the fear of how inmates would respond to me and of names they might call. Corridors were cold, stark, echoic, with a constant reminder of inmates' plight to end their lives in the endless safety netting; calls from unknown locations and cells with no relief. I don't have a mental illness, yet I felt anxious and paranoid. It left me very concerned for those that do.

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Developing patient information and clinician education resources for venous thromboembolism in a physiotherapy department in response to the COVID-19 pandemic

International Journal of Therapy and Rehabilitation ◽

10.12968/ijtr.2020.0081 ◽

2020 ◽

Vol 27 (9) ◽

pp. 1-7

Author(s):

Chris Drake ◽

Nicola Hicks ◽

Leanne Atkin

Keyword(s):

Venous Thromboembolism ◽

Disease Burden ◽

Interdisciplinary Approach ◽

Information Resources ◽

Face To Face ◽

Physiotherapy Department ◽

Clinician Education ◽

Patients At Risk ◽

The Uk ◽

Safety Netting

Venous thromboembolism is a major contributor to global disease burden and is associated with significant morbidity and mortality. Physiotherapists often encounter people who are at elevated risk of venous thromboembolism, and as such are a vital part of an interdisciplinary approach to the prevention and management venous thromboembolism. In response to the COVID-19 pandemic, appropriate and accessible patient and clinician information resources regarding venous thromboembolism are of paramount importance, to facilitate safety netting and optimise health outcomes with minimal face-to-face contact. This article describes an interdisciplinary approach to the development of patient and clinician information resources within an acute hospital physiotherapy department in the UK. This was conducted with the intention of providing appropriate safety netting for patients at risk of lower extremity venous thromboembolism and to actively facilitate prevention, detection and early intervention.

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Spontaneous pneumomediastinum and subcutaneous emphysema in a child with unknown aetiology

BMJ Case Reports ◽

10.1136/bcr-2018-226805 ◽

2019 ◽

Vol 12 (2) ◽

pp. e226805

Author(s):

Anoopkishore Chidambaram ◽

Sirisha Donekal

Keyword(s):

Subcutaneous Emphysema ◽

Rare Entity ◽

X Ray ◽

Spontaneous Pneumomediastinum ◽

Expert Opinions ◽

Repeat Chest ◽

Chest X Ray ◽

Red Flag ◽

Surgical Emphysema ◽

Safety Netting

Spontaneous subcutaneous emphysema and pneumomediastinum in children without any predisposing factors is a rare entity. We present a case of an adolescent boy with spontaneous pneumomediastinum. He is a 14-year-old boy brought to the hospital with an odd feeling in the neck and chest. Initial chest X-ray revealed subcutaneous emphysema and pneumomediastinum. He was further evaluated with CT thorax and abdomen with contrast which revealed extensive pneumomediastinum with associated surgical emphysema in the chest wall and neck. Expert opinions from the cardiothoracic and respiratory teams were obtained. The child was discharged with safety netting and description of red flag signs. Repeat chest X-ray in 2 weeks showed complete resolution of the pneumomediastinum and subcutaneous emphysema. We will briefly discuss about the diagnosis and treatment of spontaneous pneumomediastinum and subcutaneous emphysema.

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G28 Effective safety netting: an important contribution to avoiding preventable deaths

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308599.28 ◽

2015 ◽

Vol 100 (Suppl 3) ◽

pp. A12.1-A12 ◽

Cited By ~ 1

Author(s):

SJ Neill ◽

CHD Jones ◽

D Roland ◽

M Thompson ◽

M Lakhanpaul

Keyword(s):

Safety Netting

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Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data

British Journal of General Practice ◽

10.3399/bjgp18x695813 ◽

2018 ◽

Vol 68 (670) ◽

pp. e323-e332 ◽

Cited By ~ 9

Author(s):

Brian D Nicholson ◽

Clare R Goyder ◽

Clare R Bankhead ◽

Berit S Toftegaard ◽

Peter W Rose ◽

...

Keyword(s):

Primary Care ◽

Secondary Analysis ◽

Diagnostic Process ◽

Free Text ◽

Theory Approach ◽

Test Results ◽

Primary Care Practitioners ◽

Grounded Theory Approach ◽

Safety Netting

BackgroundIt is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained.AimTo explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions.Design and settingA secondary analysis of survey data from the International Cancer Benchmarking Partnership.MethodThe authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach.ResultsPCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, ‘double safety netting’ is described, where both patient and PCP retain responsibility.ConclusionThe degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system’s properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.

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Safety netting in routine primary care consultations: an observational study using video-recorded UK consultations

British Journal of General Practice ◽

10.3399/bjgp19x706601 ◽

2019 ◽

Vol 69 (689) ◽

pp. e878-e886 ◽

Cited By ~ 4

Author(s):

Peter J Edwards ◽

Matthew J Ridd ◽

Emily Sanderson ◽

Rebecca K Barnes

Keyword(s):

Primary Care ◽

Logistic Regression ◽

Observational Study ◽

Confidence Interval ◽

Treatment Planning ◽

Odds Ratio ◽

Adult Patients ◽

Specific Advice ◽

The Uk ◽

Safety Netting

BackgroundSafety-netting advice is 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.AimTo assess when and how safety-netting advice is delivered in routine GP consultations.Design and settingThis was an observational study using 318 recorded GP consultations with adult patients in the UK.MethodA safety-netting coding tool was applied to all consultations. Logistic regression for the presence or absence of safety-netting advice was compared between patient, clinician, and problem variables.ResultsA total of 390 episodes of safety-netting advice were observed in 205/318 (64.5%) consultations for 257/555 (46.3%) problems. Most advice was initiated by the GP (94.9%) and delivered in the treatment planning (52.1%) or closing (31.5%) consultation phases. Specific advice was delivered in almost half (47.2%) of episodes. Safety-netting advice was more likely to be present for problems that were acute (odds ratio [OR] 2.18, 95% confidence interval [CI] = 1.30 to 3.64), assessed first in the consultation (OR 2.94, 95% CI = 1.85 to 4.68) or assessed by GPs aged ≤49 years (OR 2.56, 95% CI = 1.45 to 4.51). Safety-netting advice was documented for only 109/242 (45.0%) problems.ConclusionGPs appear to commonly give safety-netting advice, but the contingencies or actions required on the patient’s part may not always be specific or documented. The likelihood of safety-netting advice being delivered may vary according to characteristics of the problem or the GP. How to assess safety-netting outcomes in terms of patient benefits and harms does warrant further exploration.

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