What type of communication is demonstrated when a physician orders epinephrine, the nurse repeats the order back, and the physician confirms it?

Closed-Loop Communication

The scenario described is closed-loop communication (Option A), where the physician gives an order ("give epinephrine"), the nurse repeats it back ("give epinephrine"), and the physician confirms the message was correctly understood ("yes"). 1

Definition and Components

Closed-loop communication is defined as a model of transmission in which verbal repetition is of prime importance to ensure that team members have correctly understood the message. 1 This three-step process includes:

• Sender issues the order (doctor: "give epinephrine") 1
• Receiver repeats back the order (nurse: "give epinephrine") 1
• Sender confirms understanding (doctor: "yes") 1

Why This Matters for Patient Safety

The 2023 Anaesthesia guidelines on human factors in critical situations strongly recommend closed-loop communication to reduce morbidity and mortality. 1 The evidence demonstrates:

• Closed-loop communication reduces medical errors and improves composite mortality/morbidity scores (OR 4.82, CI95% 1.30-17.87) 1
• Faulty communication is the most frequent cause of incorrect surgical procedures (wrong patient, side, site, procedure, or implantable medical device) 1
• Simulation-based closed-loop communication training reduces medical errors and improves team efficacy in pediatric trauma resuscitation 1

Distinguishing From Other Communication Types

This is not "call-out" or "check-back" as standalone terms, though these may be used interchangeably in some contexts. The key distinguishing feature is the complete three-step loop: order → repeat-back → confirmation. 1, 2

Real-World Usage Patterns

Despite strong recommendations, closed-loop communication remains underutilized in clinical practice:

• Only 45% of call-outs in real-life interprofessional emergency teams used closed-loop communication 2
• In cardiac catheterization labs, complete closed-loop communication occurred in only 38-79% of medication orders even after quality improvement efforts 3, 4
• When closed-loop and directed communication were used together, action completion rates reached 100% versus 81% when neither was used (P=0.030) 5

Common Pitfalls

• Incomplete loops are common: acknowledgment without repetition, or repetition without confirmation, both compromise safety 3, 4
• Medication orders receive better closed-loop communication than equipment orders in practice 3, 4
• Time pressure and competing demands can disrupt the communication loop, leading to dropped tasks 5, 6