Objectives. Communication failure is one of the most common causes of adverse events in hospitals and poses a direct threat to patient safety. Research recommends the use of closed-loop communication in interprofessional emergency teams to prevent such events. Multiple studies have examined closed-loop communication during simulation training, but few have investigated its use in clinical practice. The aim of the study was to explore the use of closed-loop communication by anesthesia personnel in real-life interprofessional emergency teams. Methods. This study had a descriptive, cross-sectional design where structured field observations were used to assess anesthesia personnel’s use of closed-loop communication in real-life interprofessional emergency teams. A total of 60 interprofessional teams were observed, including 120 anesthesia personnel at a hospital in South-Eastern Norway. Data were analyzed using descriptive statistics. Results. A total of 1626 call outs were registered, in which closed-loop communication was applied in 45%. Closed-loop communication was used more frequently when call outs were directed using eye contact and when the call outs were medication orders. There was no difference in the use of closed-loop communication between nurse anesthetists and anesthesiologists. Closed-loop communication was used more frequently in cardiac arrest teams than in trauma teams. Conclusions. The findings in this study have contributed knowledge about anesthesia personnel’s use of closed-loop communication in real-life interprofessional emergency teams and indicate a potential for improvement. Further research is needed about real-life interprofessional emergency teams' communication patterns and potential barriers from using closed-loop communication, with the aim to improve patient safety.
Commentaire du Dr Marius Laurent (PAQS)
- La communication en boucle fermée (closed-loop communication) comprend l’émission d’un message dont le destinataire est identifié (soit explicitement soit par la direction du regard), la communication par le destinataire de sa réception par l’émission d’une paraphrase de celui-ci, et enfin une confirmation par l’émetteur que le message a été reçu et compris. Cette discipline est enseignée et recommandée en Norvège, d’où vient l’étude, en tout cas dans les équipes d’anesthésie. L’étude a été réalisée dans un milieu probablement très sensibilisé à la sécurité du patient (centre de traumatologie, la plupart des activités soumises à l’étude sont du domaine de la réanimation), ce qui explique sans doute une adhésion « satisfaisante mais perfectible » à la méthode : 45% des messages satisfont aux trois critères. Notons que dans l’aviation, d’où le concept est issu, on est proche des 100%. Des formations spécifiques à ce type de communication, ou des formations plus générales aux non-technical skills telles que TeamSTEPPS par exemple (formation promue en Suisse et en Belgique, où elles sont réalisées en français) améliorent l’adoption de ce protocole.
Gjøvikli K, Valeberg BT.Closed-Loop Communication in Interprofessional Emergency Teams : A Cross-Sectional Observation Study on the Use of Closed-Loop Communication Among Anesthesia Personnel. J Patient Saf 2023;19(2):93-98. Doi : 10.1097/pts.0000000000001098.