How does an effective ending improve patient safety and help to prevent complaints?

Introduction

All consultations come to an end and when suitable explanations for a personalised care plan are in place the ending of the consultation should be straightforward. In addition, there are specific skills to bring the consultation to an ending that feels satisfactory for both clinician and patient.

Investing in the beginning

Clinicians in training frequently bemoan the ‘handle on the door moment’, when a patient brings up a previously unmentioned concern, just as the clinician thought the consultation was at an end. There can be many reasons for this, some of which are appropriate and unavoidable. However many late-arising issues can be prevented if clinicians use the skills of investing in the beginning by building rapport, screening for multiple issues and setting an agreed agenda (Danczak, 2024). A marked reduction in surprises at the end of the consultation will happen when the clinician is sensitive to hidden issues, responding effectively to clues and cues from the start of the consultation.

Confirm the plan of care and next steps

The process of developing a mutually agreeable, person-centred management plan is sometimes referred to as ‘contracting’, which captures the idea that both parties need to be in agreement about a suitable plan for future care. Being explicit about next steps for both patient and clinician ensures clarity and helps to signal that the consultation is moving towards a close.

Safety netting

First coined by Roger Neighbour (Neighbour, 1987), safety netting has become a catch-all phrase to encompass general advice exchanged at the end of consultations. This may take a very cursory form ‘come back if things aren’t better’. Neighbour suggests safety netting includes three key questions for the clinician to ask themselves:

If I am right, what will I expect to happen?

As in other areas of the consultation, effective safety netting is personalised to the unique needs of the patient, taking into account their specific problems and giving tailored advice about what to do should things not progress as expected.

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Clinicians developing their consultation skills use the Neighbour framework to develop the process of safety netting until it becomes very natural. In some situations it might be appropriate to write safety-netting instructions down for a patient, or to anticipate a specific possibility or give very direct instructions about seeking additional care.

Summary and final check

Summarising is an essential tool for the closing phases of the consultation. It is a useful aid to accuracy and adherence because it provides an opportunity for clinician and patient to ‘confirm their deliberations’, a final check that the patient is happy with things. Asking, ‘what questions do you have now?’ ensures nothing is missed. Summarising with adequate space for patient questions and checking understanding improves safety while increasing patient satisfaction.

Reducing complaints

When complaints occur, common issues include a lack of clarity about when or how to seek further care. This is often owing to inadequate safety netting, especially if there has been no explicit checking of the patients understanding of what might happen next. Using skills that promote effective endings helps to avoid these problems, creates a better patient experience and improves patient safety. This reduces the likelihood of complaints.