Factors affecting the documentation of spoken safety-netting advice in routine GP consultations: a cross-sectional study

Background: Previous studies have reported how often safety-netting is documented in medical records, but it is not known how this compares to what is verbalised and what factors might influence the consistency of documentation. Aim: To compare spoken and documented safety-netting advice (SNA) and explore factors associated with documentation. Design and setting: Secondary analysis of GP consultations archive. Method: Observational coding involving classifying and quantifying medical record entries and comparison with spoken SNA in 295 video / audio recorded consultations. Associations were tested using logistic regression. Results: Two-thirds of consultations (192/295) contained spoken SNA which applied to less than half of problems assessed (242/516). Only one-third of consultations (94/295) had documented SNA which covered 20% of problems (105/516). The practice of GPs varied widely from those that did not document their SNA, to those that nearly always did so (86.7%). GPs were more likely to document their SNA for new problems (p=0.030), when only a single problem was discussed in a consultation (p=0.040) and when they gave specific, rather than generic SNA (p=0.007). In consultations where multiple problems were assessed (n=139), the frequency of spoken and documented SNA decreased the later a problem was assessed. Conclusion: GPs frequently do not document safety-netting advice they have given to patients which may have medico-legal implications in the event of an untoward incident. GPs should consider how safely they can assess and document more than one problem in a single consultation and this risk should be shared with patients to help manage expectations.