Communication in Healthcare: Closing the Loop

Anytime that I repeat myself, my teenagers reflexively go into a routine of extreme eye rolling and reminding me that I already told them or asked them “that”...

“Did you clean your room?”

“Make sure that you take the dogs out.”

“Please clean up your ____.” [complete sentence with any object left on the floor or a piece of furniture]

Those are but a few of the statements that have escaped my mouth on more than one occasion. However, never in my wildest dreams would I have thought that repeating myself would be a virtue and could be received with appreciation, along with the expectation that I should repeat myself. Well, that is exactly what closed-loop communication has brought me…appreciation and acceptance for a behavior that is deemed as a sign of a forgetful or annoying parent. What a gift!

In all seriousness, closed-loop communication is a crucial practice in medicine. The idea is that one should guarantee that information is being relayed correctly. Having the sender of the information and the receiver of the information repeating the message ensures that the information is the same on both fronts of communication to eliminate miscommunication. Closed-loop communication is important during medication administration to make sure that the type and dose of a medicine is given correctly. Closed-loop communication is important when generating a patient care plan with the medical team on rounds and having the staff summarize the plan and the leader on rounds confirming that the summarized plan is correct. Closed-loop communication is important when performing a medical procedure to ensure what the procedure is and where in or on the body it is being performed.

Closed-loop communication works like this…

1. The sender initiates a message

2. The receiver acknowledges the message and repeats the message back to make sure the message was understood correctly

3. The sender confirms the message is correct to close the loop

An example of closed-loop communication is:

Sender: “Can you please give Mr. Jones 2 mg of IV morphine now?”

Receiver: “I am going to give Mr. Jones 2 mg of IV morphine now.”

Sender: “Yes, please give Mr. Jones 2 mg of IV morphine now.”

While the exact statement request may not be repeated by the sender, the restated message of the receiver is confirmed in some form or fashion by the sender. This decreases ambiguity and improves accuracy in relaying information because both the sender and the receiver are required to state the same message.

Being specific and detailed about a request is critical to providing proper patient care in medicine. While it may seem demeaning by stating requests in detail and having the requests relayed and confirmed in similar detail, it is by no means to be meant as degrading or condescending. It is the standard for communicating amongst high-performing medical teams. Closed-loop communication prevents catastrophic outcomes in mundane situations and optimizes the precision needed in orchestrating complex tasks to preserve life under the most life-threatening circumstances. Closed-loop communication may not be the best tactic in parenting teenagers, but it surely ensures the safest care in medicine.

What is your experience with closed-loop communication? Do you practice closed-loop communication regularly?