miscommunication, the aviation industry adopted closed-loop communication principles to enhance safety. This became an integral part of Crew Resource Management (CRM), that emphasizes best practices for aircrews and supporting personnel and plays a vital role in preventing accidents caused by miscommunication. Application in Medicine In the medical field, closed-loop communication is crucial for ensuring patient safety and quality care. It helps to prevent errors, improve outcomes, and enhance patient satisfaction, and studies have shown its importance in the relationship between members of healthcare teams, different medical specialties, patients and caregivers, and trauma teams. For example, a study evaluating the ability of closed-loop communication to improve time-to-task- completion in pediatric trauma activations found that there was a significant reduction in time-to-task-completion when closed-loop communication was utilized and that orders with closed-loop communication were completed almost four times more quickly than orders via open-loop communication. Another study found a 75% decrease in medical errors after adopting closed-loop communication in an emergency department. Paging systems are a ubiquitous form of communication in the healthcare setting. In its usual form, paging is a one-way communication system that involves an indirect, delayed response from a different device such as a
paging terminal or telephone system. However, when real-time, closed-loop communications are needed, traditional paging systems may be inadequate. Use of communications systems such as mobile phones, texting systems, or hands-free voice-activated devices provides instant access to individuals of the care team, enables staff to communicate quickly, and improves overall communication. Closed-loop communication is critical in conveying test results accurately and ensuring appropriate follow-up. The Joint Commission, in its Quick Safety Issue 52, addressed the importance of closed-loop communication in reporting test results and included a case report in which a woman who underwent mammography was not informed she required follow up due to a suspicious area of calcifications. When she was finally notified of the abnormality a year later at a check-up with her primary care physician, she was diagnosed with stage 3 advanced breast cancer. Failure to communicate “sub-critical” test results promptly can lead to delayed care, compromised patient safety, and distress. Implementing consistent processes, notifying patients of critical results through verbal means with confirmation of receipt, and establishing alternative channels for unacknowledged results are crucial steps to reduce diagnostic errors. room provides a practical setting for the implementation of closed-loop communication. Consider the following example: Example 1A During vascular operations, anesthesia providers are often asked to administer heparin to reduce the risk of thrombosis. In an arterio-venous shunt placement, the vascular surgeon verbally announces to the room, “Let’s give 6,000 units of heparin,” without directly addressing the anesthesia provider. Amidst ongoing vocal communications and elevated ambient noise, the anesthesia provider does not hear the request for heparin administration. Approximately 30 minutes later, the surgeon looks up and asks the anesthesia provider how long it has been since the administration of heparin. The anesthesia provider explains that no heparin has been given In anesthesia practice, the operating
industry, through Crew Resource Management, has demonstrated the positive impact of closed- loop communication on enhancing safety and reducing errors. Recognizing the importance of closed- loop communication, regulatory bodies like The Joint Commission have addressed its significance and provided recommendations to enhance communication practices, especially in critical areas such as reporting test results and reducing diagnostic errors.
due to the initial request being unheard.
Now, consider the same scenario in an environment that consistently employs closed- loop communication. Example 1B The same situation unfolds as described earlier. While performing the operation, the surgeon announces to the room, “Let’s give 6,000 units of heparin.” Amidst other vocal communications and ambient noise, the anesthesia provider does not hear the request for heparin administration. However, since the surgeon does not hear a confirmation from the anesthesia provider, the surgeon pauses and makes direct eye contact, repeating the request, “Can you give 6,000 units of heparin, please?”. The anesthesia provider promptly responds, “Absolutely! 6,000 units of heparin” and seeks clarification, asking, “Would you like that to be administered now?”. The surgeon confirms the IV route of administration and asks the anesthesia provider to verify once the dose has been given. A few minutes later, after the heparin has been prepared, the anesthesia provider announces, “Heparin 6,000 units IV, being given now.” The surgeon says “Thank you”, acknowledging the anesthesia provider’s response. Conclusion In conclusion, closed-loop communication is a vital element in effective and safe communication within various industries, including healthcare. It serves as a powerful tool to mitigate potential errors, misunderstandings, and misinterpretations that can have serious consequences. By establishing a feedback loop between the sender and receiver, closed-loop communication ensures that messages are accurately transmitted, received, and understood. Throughout history, incidents in aviation and healthcare have highlighted the dire consequences of inadequate communication practices. These experiences have led to the development and implementation of closed-loop communication principles, such as the use of standardized terminology, read-backs, and acknowledgement of messages. The aviation
Two colleagues engaging in closed-loop communication. The receiver acknowledges and repeats the message, and the sender verifies receipt and accuracy.
In anesthesia practice, the operating room exemplifies a practical setting where closed-loop communication can be effectively applied. The examples discussed highlight the stark contrast between a communication breakdown and the successful implementation of closed-loop communication, emphasizing the critical role it plays in ensuring patient safety and optimal care delivery. By embracing closed-loop communication as a standard practice, healthcare professionals can create an environment of clear and effective communication, fostering collaboration, reducing errors, and ultimately improving patient outcomes. As we continue to prioritize patient safety and quality care, integrating closed-loop communication principles into everyday clinical practice will be paramount, helping us bridge the gap between intention and understanding, and ensuring that the single biggest problem in communication—the illusion that it has taken place—is effectively addressed.
Closed-loop communication is particularly important in the operating room where medication errors can lead to catastrophic complications.
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