Diaz Maria Carmen G, Dawson Kimberly
Nemours/Alfred I. du Pont Hospital for Children, Wilmington, DE.
Am J Med Qual. 2020 Dec;35(6):474-478. doi: 10.1177/1062860620912480. Epub 2020 Mar 23.
Closed-loop communication (CLC) promotes a shared understanding of information. The authors hypothesized that simulation-based CLC training would improve staff perceptions of CLC ability and decrease medical errors. Participants experienced 2 hands-on CLC simulations one month apart. A retrospective chart review of Emergency Severity Index (ESI) 1 patients was conducted 4 months pre and post CLC simulation-based training. Seventy simulations were held over 13 weeks. Staff perceptions of CLC ability improved and were sustained after one month. Nine ESI 1 patients were seen pre CLC, and 9 post; 8/9 pre-CLC ESI 1 patients had medical errors, with 19 total errors noted; 5/9 post-CLC ESI 1 patients had medical errors, with 5 total errors noted (rate ratio [99% CI] = 3.8 [1.4, 10.2]; = .008). This simulation-based CLC training curriculum improved staff perceptions of their CLC ability and was associated with a significant decrease in the number of medical errors in ESI 1 patients.
闭环沟通（CLC）促进了对信息的共同理解。作者假设基于模拟的CLC培训将提高工作人员对CLC能力的认知，并减少医疗差错。参与者在相隔一个月的时间里经历了两次实践CLC模拟。在基于CLC模拟的培训前后4个月，对急诊严重程度指数（ESI）1级患者的病历进行了回顾性审查。在13周内进行了70次模拟。工作人员对CLC能力的认知得到改善，并在一个月后得以维持。在CLC之前观察到9例ESI 1级患者，之后观察到9例；9例CLC前ESI 1级患者中有8例出现医疗差错，共记录到19次差错；9例CLC后ESI 1级患者中有5例出现医疗差错，共记录到5次差错（率比[99%CI]=3.8[1.4,10.2]；P=.008）。这种基于模拟的CLC培训课程提高了工作人员对其CLC能力的认知，并与ESI 1级患者医疗差错数量的显著减少相关。
