Closed Loop Communication Training in Medical Simulation

Excerpt

Effective interprofessional teamwork and communication are integral to patient safety. The Institute of Medicine highlighted the effect of poor communication on deleterious healthcare outcomes in the 1990s. Detrimental outcomes caused by preventable errors are commonly the result of multiple human factors, as opposed to one single error by an individual. Reason et al. argue that in medicine, every sequential step in a process has the potential for failure, and medical professionals should be vigilant of this reality.[2] Commonly, such failures are the result of inadequate communication. Miscommunication is to blame for up to 30% of malpractice awarded lawsuits, where a patient is incapacitated or killed, according to the Control Risk Insurance Company.

The future of patient safety and avoidance of medical errors should be predicated upon systems based error prevention as opposed to sole reliance on a healthcare provider’s vigilance. Handoff periods are particularly vulnerable to deficiencies in verbal communication due to language impediments, misunderstandings, interruptions, and hesitation to speak up against authority. Successful communication strategies are fundamental to productive team structure, collaboration, and task completion. Standardized communication systems have been developed to reduce the risk of inappropriate information transfer. The field of aviation has led to significant changes in team training concepts to increase patient safety, known as Crew Resource management. Closed-loop communication (CLC), including a call-out(CO), is based upon the use of standardized terminology and procedures to ensure safe communication. A CO is a primary verbalization used to make the team aware of a meaningful change or observation in regards to patient care. CLC is a communication model originating from military radio transmissions based on verbal feedback to ensure proper team understanding of a meaningful message. CLC is a three-step process, where 1) the transmitter communicates a message to the intended receiver, utilizing their name when possible, 2) the receiver accepts the message with acknowledgment of receipt via verbal confirmation, seeking clarification if required and 3) the original transmitter verifies that the message has been received and correctly interpreted, thereby closing the loop.