Closed-Loop Communication

Close the loop to prevent miscommunication and missteps.

In closed-loop communication, the person receiving instruction or information repeats it back to make sure the message is understood correctly, and the sender confirms to “close the loop.” It does not require more time, and in fact, it is likely to save time. But ultimately, it's an important tool that protects our patients from communication errors that can lead to serious consequences.

What is Closed-Loop Communication?

See It In Action

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Use closed-loop communication frequently.

Closed-loop communication is not just for chaotic or emergent situations. Consider using it when providing any request in your daily practice to ensure everyone has a shared mental model.

Question 1 of 2
Did they close the loop?

As Heather begins her shift, the day shift nurse tells her which vital signs to monitor for a high-risk patient recovering from a total hip replacement. Heather responds: “OK, got it,” and the day nurse leaves.

Did Heather close the loop?


Not exactly. Heather didn’t “check back” by repeating the information, and the day nurse didn’t confirm whether it was correct, so neither one of them has a way of knowing whether the message got through.


Good job! To truly close the loop, Heather would have repeated the information back and then have the day nurse confirm its accuracy.

Question 2 of 2
Did they close the loop?

While assisting with a routine procedure, Jaxon notices that the surgeon’s call-out instructions were not directed at anyone, so he doesn't take any action.

Did Jaxon close the loop?


Not quite. Because Jaxon chose to proceed without clarifying who the call-out was for, he didn’t give the surgeon a chance to verify the instructions and close the loop.


Nice work! If Jaxon had clarified who the call-out was for, he would have given the surgeon a chance to direct the call-out and then close the loop.

Put It Into Practice
00:00/ 00:00

Can you help Dr. Evans close the loop?

Do you know who is responsible for calling for the x-ray?


Not quite! The physician asking for the x-ray did so as a general request, but because everyone was busy and she didn't call out anyone in particular, it's hard to say who exactly is responsible for following up.


That's okay—how could you have known? The doctor asking for the x-ray did so as a general request, but because everyone was busy and she didn't call out anyone in particular, it's hard to say who exactly is responsible for following up.


What could the physician have done differently to ensure that the request would be completed?

Repeat the request until somebody volunteers.

Not quite. This kind of approach will likely hurt rapport with team members. It would be better to direct a specific request to a team member by name, and then verbally confirm that they are taking the appropriate next steps.

Direct the request to someone by name and then clarify that it was understood.

That's right! By addressing a specific person and then verifying that they heard it correctly, you won't have to make any assumptions about the work getting done.


Close the loop to confirm instructions.

When calling out specific instructions for a patient’s care—for example, making sure the patient gets out of bed at least four times a day—closing the loop will ensure these instructions are followed so ineffective communication won't interfere with the patient’s recovery.


Close the loop with patients and family members.

When meeting with or providing care to patients and their families, ask them to close the loop or provide an opportunity for a check-back so they can repeat back what they heard from the care team.


Close the loop when ordering or administering medication.

Not closing the loop could result in administering the wrong dose or type of medication, which could lead to an adverse outcome for the patient.


Close the loop when ordering tests.

It's always important to use closed-loop communication when ordering any tests or procedures for a patient. For example, if an order for an ABG test is ignored or misinterpreted, this could delay diagnosis and critical care.


Call out, check back and verify to close the loop.

Closed-Loop Communication Module - Sender Initiates Message | Receiver Repeats Message Back | Sender Verifies the Message

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