Tools for ‘safety netting’ in common paediatric illnesses: a systematic review in emergency care

Abstract

ContextFollow-up strategies after emergency department (ED) discharge, alias safety netting, is often based on the gut feeling of the attending physician.ObjectiveTo systematically identify evaluated safety-netting strategies after ED discharge and to describe determinants of paediatric ED revisits.Data sourcesMEDLINE, Embase, CINAHL, Cochrane central, OvidSP, Web of Science, Google Scholar, PubMed.Study selectionStudies of any design reporting on safety netting/follow-up after ED discharge and/or determinants of ED revisits for the total paediatric population or specifically for children with fever, dyspnoea and/or gastroenteritis. Outcomes included complicated course of disease after initial ED visit (eg, revisits, hospitalisation).Data extractionTwo reviewers independently assessed studies for eligibility and study quality. As meta-analysis was not possible due to heterogeneity of studies, we performed a narrative synthesis of study results. A best-evidence synthesis was used to identify the level of evidence.ResultsWe summarised 58 studies, 36% (21/58) were assessed as having low risk of bias. Limited evidence was observed for different strategies of safety netting, with educational interventions being mostly studied. Young children, a relevant medical history, infectious/respiratory symptoms or seizures and progression/persistence of symptoms were strongly associated with ED revisits. Gender, emergency crowding, physicians’ characteristics and diagnostic tests and/or therapeutic interventions at the index visit were not associated with revisits.ConclusionsWithin the heterogeneous available evidence, we identified a set of strong determinants of revisits that identify high-risk groups in need for safety netting in paediatric emergency care being related to age and clinical symptoms. Gaps remain on intervention studies concerning specific application of a uniform safety-netting strategy and its included time frame.

Unplanned reattendances at the paediatric emergency department within 72 hours: a one-year experience in KKH

“…(29) At the same time, other studies have shown that the level of training of the primary doctor was not significantly associated with admission rates. (13,30,31) The presence of comorbidities was independently associated with higher likelihood of being admitted at reattendances, notably for respiratory comorbidities. Hence, healthcare institutions may wish to consider focusing interventions on respiratory conditions and increasing accessibility in the primary outpatient setting.…”

Safety netting for primary care: evidence from a literature review

“…This literature review has identified definitions and the key components of safety netting. studies, five were audit or case reviews, [48][49][50][51][52] three were systematic reviews, [53][54][55] one was a Delphi study, 16 and one was a protocol for a randomised controlled trial. 56…”

“…Of the included citations, 30 offered a definition of safety netting. 5,6,8,9,13,14,16,[19][20][21][22][23]25,[27][28][29]33,[36][37][38]41,43,44,46,47,49,[51][52][53]55 Although this differed among included articles, several themes were common throughout the literature. These data are presented in Table 1.…”

Antibiotic Stewardship and Hospital Hygiene in German Paediatric Inpatient Facilities: A Qualitative Survey from the Paed IC Working Group

“…Case by case discussions enable the attending physicians not only to understand the basic principles of judicious use of antimicrobials [25]. Regional PID networks may be suitable instruments to promote patient safety [11] There is always some degree of resistance among physicians to adopt ABS interventions (30 % prevalence of active resisters in this survey) [40], some may be reluctant to allow such a program to interfere with their therapeutic autonomy. Recent data from other surveys elucidate that most physicians eventually realize and appreciate the substantial benefit of paediatric inpatient ABS programs [25].…”