E-safety netting tools

What are e-safety netting tools?

e–Safety-netting tools are electronic systems designed to improve the tracking and follow-up of patients who may be at risk of cancer. They can be integrated into electronic health records, or provided by a separate software. Typical functions include: clinician alerts, administrative tasking, templates for standardised codes, tracking dashboards, and additional support (e.g. prepopulated referral forms).  

Consistent use of e-safety netting tools may reduce variation in safety netting practices, reduce the chance of diagnostic errors and delay and support quality improvement via the provision of better audit data around safety-netting [1].  

How can e-safety netting tools support clinicians?

Structured documentation - templates provide structured fields for consistently capturing and coding information from patient consultations, such as whether safety netting advice was given or a follow-up appointment arranged. Tools can also suggest or pre-populate relevant safety netting templates based on coded information - for example, a suspected lung cancer code triggering lung-specific safety netting actions.  
Automated reminders and alerts - prompt clinicians to follow up on patients with unresolved symptoms, abnormal test results or pending referrals.  
Patient communication – generate letters, texts or e-mails including safety netting information for patients to refer back to.
Patient tracking - track patients over time to check if they’ve engaged with safety-netting advice, investigations or referrals and ensure the appropriate follow-up occurs.  

How can e-safety netting tools support practices?

Centralised dashboards - identify patients across the practice who need to be followed-up so contact can be coordinated.  
Patient communication support - automate and record outreach to patients for example sending text reminders or letters to encourage attendance for tests or follow-up appointments.  
Task management - assign, track and manage safety-netting tasks across the team to improve visibility, communication and accountability.  
Equity monitoring - identify patient groups less likely to engage or re-present to support targeted follow-ups and reduce inequalities.  

 

 

How can e-safety netting tools be evaluated?  

There are multiple different e-safety netting tools available across the UK, all with different system compatibility, functions and potential cost. A framework for evaluating e-safety netting tools has been developed, which could aid health systems when deciding whether to implement a tool in their practice . The principles of a high-quality e-safety netting tool include [1]:  

  • All patients registered will be e–safety-netted 

  • All clinicians and primary care staff are responsible for e–safety-netting 

  • Limit burden and cognitive bias by using automatic functions, where possible 

  • Support diagnostic processes before, during, and after consultations 

  • Monitor, auto-detect, and measure pathway process errors or deviations and alert the relevant people 

  • Use simple processes that make it easy to access and transfer complex information 

  • Spread responsibilities and roles within primary care that have an overall impact on the whole patient pathway 

  • Support senior leadership to optimise safety strategies within a regular quality improvement program 

  • Allow for patient interaction and feedback 

There are currently no tools available that meet all of the criteria in the framework, but it is a useful guide to appraise whether an e-safety netting tool will add sufficient value in practice.  

Examples of e-safety netting tools  

Below we’ve listed some examples of available safety netting tools that are compatible with the most commonly adopted electronic health systems used across the UK: 

  • EMIS E-SN tool (Optum): this free to use tool includes features such as tracking direct access to investigations, urgent suspected cancer referrals and monitoring symptoms. The tool provides primary care staff with a way to record safety-netting advice and actions and to set reminders to ensure that the patient is followed-up. This is currently compatible with EMIS. Follow the links for more information about the tool, and how to use it in your practice.  

  • SystmOne safety netting features: the free, built-in features of SystmOne allow health professionals to schedule tasks, templates, and utilise SNOMED coding to track cancer-related tests and referrals. For more information, click here.  

  • Vision safety netting features: free templates and workflows are built into Vision including custom templates for safety-netting, the ability to schedule tasks and alerts, use of read/SNOMED codes to trigger follow-up reminders, ability to log diagnostic status and pending results. For more information, click here.  

  • Ardens: Fast track safety netting tools within Ardens uses templates that allow tracking of referrals, diagnostic test results and setting safety netting alerts for follow-ups with patients. Ardens is compatible with SystmOne and EMIS (Optum). Note, this system has a cost associated. For more information on how to use Ardens, click here.  

Supporting resources 

References

1. Black, G. B., et al. Harnessing the Electronic Health Care Record to Optimize Patient Safety in Primary Care: Framework for Evaluating e–Safety-Netting Tools. JMIR Medical Informatics. 2022.