I declare the use of pseudonym/s within this assignment in respect of individuals and/or healthcare services. This declaration recognises the need to uphold anonymity and confidentiality where evidence related to my professional practice in healthcare is shared / disseminated.

This case study focuses on the importance of safety netting patients that are not conveyed to a definitive place of care by pre-hospital clinicians. Emergency admissions and attendances to Emergency Departments (ED) have increased every year, over the past twelve years, in England. (Blunt, Bardsley and Dixon, 2010; Appleby, 2013; The King’s Fund, 2013; Parliament. House of Commons, 2017)

After assessing a patient, there may me the option of treating the patient out of hospital, therefore, preventing a hospital admission. If the patient requires further treatment or assessment, it is important to give the patient appropriate advice, in regards to ongoing care or any complications that may occur. This needs to include who to contact and how to contact them if the condition worsens (de Vos-Kerkhof et al., 2015)

Using safety netting as a consultation technique ensures a timely reassessment of a patient (Almond, Mant and Thompson, 2009). The consultation model by Neighbour (1987) is a popular model. It consists of a five point checklist; connecting, summarising, handing over, safety netting and housekeeping.  This consultation model is easy to use and follow, this is aided by its natural flow. It is concise and promotes partnership by being patient centred. This model was originally developed for use by General Practitioners (GP), however it can be easily used by paramedics as it aims for the clinician to work within their knowledge base, freeing them from using their intuitive input (Evans et al., 2013). When safety netting a patient to leave them at home, paramedics should remember the three C’s, as shown in appendix one (Silverton, 2014). By following these processes, clinicians can question the appropriateness of the safety netting.

When it is decided that a patient can be managed in the community safely and therefore does not require admission to an ED, but does require further care, safety netting and arrangement of an alternative pathway must be carried out (South Western Ambulance Service NHS Foundation Trust, 2014). Alternatives to ED admission are varied, including, but not limited to, GP, Minor Injury Units, self care, Pharmacist, District nurses (Royal Free London NHS Foundation Trust, 2015) .

Overcrowding within ED is at crisis point and currently at the centre of national attention (Smith and Wilkinson 2017), it is important for the ambulance service to make appropriate referrals for patients. To meet the demands of the changing National Health Service (NHS), it is necessary to ensure patients are referred to the most appropriate services for their condition. According to the Commissioning for Quality and innovations (NHS England, 2015), there is an ‘increase in the number of patients with urgent and emergency care needs who are managed close to home, rather than in a hospital (A&E or inpatient) setting’. This report highlights that there is a government agenda, where, when appropriate, patients are left at home ensuring they get the right care at the right time in the right place (South, 2012).

In conclusion, patients need to be aware of why they are not being conveyed to ED and how they are being safety netted. They need to understand what they need to if their condition worsens or fails to improve. Finally patients need to understand how to seek further help if required. More research into safety netting is required to identify how to improve this process for the safety of patients.

References

Almond, S., Mant, D. And Thompson, M. (2009) ‘Diagnostic Safety-netting’, The British Journal of General Practice. 59(568), pp 872-874. Doi: 10.3399/bjgp09X472971

Appleby, J. (2013) ‘Are Accident and Emergency Attendances Increasing?’, British Medical Journal, 346, pp. 1-4. doi: 10.1136/bmj.f3677

Blunt, I., Bardsley, M. and Dixon, J. (2010) Trends in Emergency Medicine in England 2004 – 2009. Available at:  https://www.nuffieldtrust.org.uk/files/2017-01/trends-emergency-admissions-report-web-final.pdf. (Accessed: 13 March 2017)

de Vos-Kerkhof, E., Geurts, D. H. F., Wiggers, M., Moll, H. A. And Ostenbrink, R. (2015) “Tools for ‘Safety Netting’ in Common Paediatric Illnesses: A Systematic Review in Emergency Care”, Archives of Disease in Childhood. 101(2), pp. 129-131. doi: 10.1136/archdischild-2014-306953

Evans, R., McGovern, R., Birch, J. and Newbury-Birch, D. (2013) ‘Which Extending Paramedic Skills are Making an Impact in Emergency Care and can be Related to the UK Paramedic Systems, A Systematic Review of the Literature’. Emergency Medicine Journal, 31, pp. 594-603. doi: 10.1136/emermed-2012-202129

Neighbour, R. (1987) The Inner Consultation. How to Develop an Effective and Intuitive Consulting Style. Lancaster: Kluwer Academic Publisher

NHS England (2015) Commissioning for Quality and Innovation. Guidance for 2017/19. Available at: https://www.england.nhs.uk/wp-content/uploads/2016/11/cquin-2017-19-guidance.pdf (Accessed: 13 March 2017)

Parliament. House of Commons. (2017) Accident and Emergency Statistics: Demand, Performance and Pressure (6964). London: The Stationery Office.

Royal Free London NHS Foundation Trust (2016) Do you need to come to A&E? Available at: https://www.royalfree.nhs.uk/services/services-a-z/emergency-department/do-you-need-to-come-to-ae/ (Accessed 13 March 2017)

Silverton, P. (2014) ‘Reducing Risk/Improving Safety: Safe Management Plans’, Ambulance UK. 29(4). pp. 178-179

Smith, M. and Wilkinson, R. (2017) ‘One in six A&E wards under threat amid overcrowding crisis’, The Mirror, 6 February 2017. Available at: http://www.mirror.co.uk/news/uk-news/one-six-ae-wards-under-9765930 (Accessed: 13 March 2017)

South Western Ambulance Service NHS Foundation Trust (2014) Appropriate Care Pathway Policy. Available at: http://www.swast.nhs.uk/Downloads/SWASFT%20Bulletin/Bulletin%20links/Appropriate%20Care%20Pathway%20Policy.pdf (Accessed: 13 March 2017)

South Western Ambulance Service NHS Foundation Trust (2016) Right Care, Right Place, Right Time. Available at: http://www.swast.nhs.uk/right_care.htm (Accessed: 13 March 2017)

The King’s Fund (2013) Urgent and Emergency Care: A Review for NHS South of England. Available at: https://www.hsj.co.uk/Journals/2013/05/02/z/d/s/Kings-Fund-report-urgent-and-emergency-care.pdf (Accessed: 13 March 2017)

Appendix One

The three C’s in safety netting