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Simulation Based Training to Improve Closed Loop Communication in a Pediatric Emergency Department
Maria Carmen G. Diaz, MD, FAAP, FACEP; Kimberly Dawson, BSN, RN, CPEN, TCRN, EMT
Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE

Background: Ineffective communication has been associated with medical errors and poor outcomes. Closed loop communication (CLC) promotes a shared mental model by allowing team members to verbalize (call out), confirm (acknowledge and checkback) and close the loop about their understanding of information. We hypothesized that simulation-based training sessions about CLC would improve our pediatric emergency department staff's perceptions of their ability to close the loop in communication.

Methods: Staff members watched three videos of simulated resuscitation scenarios; poor CLC, good CLC, blindfolded team leader with seamless CLC. This was followed by a facilitated discussion about the value of CLC. Each staff member then participated in 2 different simulations; one 15 minutes long focusing on individualized training about proper CLC techniques. The second was an hour-long resuscitation requiring integrated use of CLC. A debrief followed that focused on integrating CLC in high stakes, low frequency events and also in daily tasks. Staff rated their perceptions about individual and team's CLC ability before (pre) and after each simulation (post 1 and post 2).

Results: 70 simulations were conducted over the span of 13 weeks, forty 15-minute and 30 hour-long. Participants included ED attendings, fellows, nurses, techs and PAs. Data may be found in Table 1.

Conclusions: Simulation is an effective tool to teach CLC. Ongoing training is needed to ensure that the skills are sustained.


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