Background: Safety netting is recommended in a variety of clinical settings, yet there are no tools to record clinician safety-netting communication behaviours.
Aim: To develop and assess the inter-rater reliability (IRR) of a coding tool designed to assess safety-netting communication behaviours in primary care consultations.
Design and setting: A mixed-methods study using an existing dataset of video-and audio-recorded UK primary care consultations.
Method: Key components that should be assessed in a coding tool were identified using the published literature and relevant guidelines. An iterative approach was utilised to continuously refine and generate new codes based on the application to real-life consultations. After the codebook had been generated, it was applied to 35 problems in 24 consultations independently by two coders. IRR scores were then calculated.
Results: The tool allows for the identification and quantification of the key elements of safety-netting advice including: who initiates the advice and at which stage of the consultation; the number of symptoms or conditions the patient is advised to look out for; what action patients should take and how urgently; as well as capturing how patients respond to such advice plus important contextual codes such as the communication of diagnostic uncertainty, the expected time course of an illness, and any follow-up plans. The final tool had substantial levels of IRR with the mean average agreement for the final tool being 88% (κ = 0.66).
Conclusion: The authors have developed a novel tool that can reliably code the extent of clinician safety-netting communication behaviours.
Keywords: clinical coding; health communication; patient safety; primary health care; reproducibility of results; safety netting; video recording.
© British Journal of General Practice 2019.