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Towards an international consensus on safety netting advice for acutely ill children presenting to ambulatory care: a modified e-Delphi procedure
  1. Ruben Burvenich1,2,
  2. Stefan Heytens2,
  3. An De Sutter2,
  4. Thomas Struyf1,
  5. Jaan Toelen3,
  6. Jan Y Verbakel1,4
  1. 1 Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
  2. 2 Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
  3. 3 Department of Development and Regeneration, KU Leuven, Leuven, Belgium
  4. 4 NIHR Community Healthcare Medtech and IVD cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Ruben Burvenich, Department of Public Health and Primary Care, KU Leuven Academic Center for General Practice, Leuven, Flanders, Belgium; ruben.burvenich{at}


Objective Develop a consensus on the content and form of safety netting advice (SNA) for parents of acutely ill children.

Design Four-round modified e-Delphi using online questionnaires and feedback among clinical and research experts.

Setting Ambulatory care in high-income countries.

Participants Forty-one experts from 13 countries: 3 emergency physicians, 15 general practitioners, 4 nurses and 19 paediatricians.

Results The experts defined the content of SNA as advice on the normal, expected disease course of the provisional diagnosis, diagnostic uncertainty, alarm signs that indicate the need for medical help and information on where and how to find such help. Regarding the form of the SNA, the experts agree that a reliable source should give SNA verbally with paper or digital written or video/image resources at every appropriate healthcare encounter in a short and simple empowering fashion, specific to the child’s situation and seek confirmatory feedback from parents.

Conclusions SNA needs to contain advice on the expected disease course, alarm signs and where and how to find help. It should be given verbally with written resources by a reliable healthcare professional or digital platform. Short, simple and specific, SNA needs to empower the parent whose understanding of the advice should be checked. The effectiveness of SNA resources coproduced by parents and experts should be assessed in different settings and those providing SNA require up-to-date and reliable training.

  • Primary Health Care
  • Nursing
  • Communicable Diseases
  • Paediatrics
  • Qualitative research

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors RB: methodology, software, formal analysis, investigation, data curation, writing—original draft, visualisation. SH: conceptualisation, methodology, writing—review and editing, supervision. ADS: conceptualisation, methodology, writing—review and editing, supervision. TS: methodology, writing—review and editing. JT: writing—review and editing. JYV: guarantor, conceptualisation, methodology, resources, writing—review and editing, supervision, project administration, funding acquisition.

  • Funding No funding was provided for this study specifically. RB is funded by a KCE investigator-led trials programme ‘KCE-181137 ARON’ where KU Leuven acts as the sponsor and University Ghent is a cooperating academic centre. The financing is mediated entirely by KU Leuven. The financial sponsor played no role in the design, execution, analysis and interpretation of data, nor in the writing of the study or the decision to submit.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.