Safety-netting advice: what to tell patients before they go home

Most patients you see in the ED go home. Safety-netting is how you keep them safe once they’ve left.

The four things to tell every patient

Before a patient goes home, tell them four things: what you think is wrong, what to watch for, exactly when and where to come back, and who will follow up. Give it in writing too if there’s any hint they’ll struggle to take it in, or if the advice is complex, and check they’ve understood it. Use a professional interpreter when you need one.

Safety-netting a child’s parents

Safety-net the parents clearly, in writing too: what to watch for, and when and where to come back.

Who needs a senior review before discharge

Most departments have a policy listing which patients need a senior review before they go home, and any high-risk patient needs one too. Present the patient with a working diagnosis and a plan.

Which patients need a senior review is set by local policy, and it varies between departments. Learn your department’s rule in your first shift.

As a guide, it’s good practice to get a senior review before any of these patients go home:

• atraumatic chest pain in anyone aged 30 or over
• fever in a child under 1
• abdominal pain in anyone aged 70 or over
• an unplanned return with the same problem within 72 hours.

When they come back

Discharge checklist

• Senior review, if the patient needs one
• Every result checked, including pending ones
• Diagnosis explained in plain words
• Safety-net given out loud and in writing
• Follow-up arranged, and the patient knows it
• GP letter written
• Medicines explained, particularly any opioids
• Transport home, and someone at home if needed
• Seen walking, if they’re older or injured
• Capacity documented, if relevant
• Interpreter used, if needed
• Board updated

More on how the ED works in the emergency medicine survival guide.