Check-back is the process of employing closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended.
2. Receiver accepts the message and provides feedback
3. Sender double-checks to ensure that the message was received
Check-Back is one of the TeamSTEPPS communication skills. In our environment, it is not routinely used and it may feel awkward to complete steps 2 and 3. In just the few short weeks following the completion of TeamSTEPPS training in the PICU, SICU and Respiratory Therapy departments, we have examples of patient harm prevented because of the use of Check-Back. Commercial aviation and military operations require and expect all communicators to use check-back. Why shouldn’t we? Receivers repeat back requests. Senders request check-backs and acknowledge the information is correct.
Doctor: “Give 25 mg of Benadryl IV push”
Nurse: “25 mg Benadryl IV push”
Doctor: “That’s correct”
Another example of check-back is available in this video – enjoy!
Call-Out is a strategy used to communicate important or critical information.
- Informs all team members simultaneously during team events
- Helps team members anticipate next steps
- Helps create a shared mental model
Call-Out is one of the TeamSTEPPS communication skills. A call-out may be requested or provided without request when important information needs to be shared as in the examples below.
Requested Call-Out example:
Leader: “Jane, please call out O2 sats every 5 mins”
Jane: “OK, sats 95% now.”
Provided without request Call-Out example:
Jane: “We don’t have positive CO2 detection following the intubation.”
This short video of the Apollo 17 landing approach to the moon, the last manned moon landing, shows multiple call-outs of altitude and pitch angle and one check-back.
Handoff is the transfer of information (along with authority and responsibility) during transitions in care across the continuum: to include an opportunity to ask questions, clarify, and confirm.
- Responsibility – when handing off, it is your responsibility to know that the person who must accept responsibility is aware of assuming responsibility.
- Accountability – You are accountable until both parties are aware of the transfer of responsibility.
- Uncertainty – When uncertainty exists, it is your responsibility to clear up all ambiguity of responsibility before the transfer is completed.
- Communicate verbally – You cannot assume that the person obtaining responsibility will read or understand written on non-verbal communications.
- Acknowledged – Until it is acknowledged that the handoff is understood and accepted, you cannot relinquish your responsibility.
- Opportunity – Handoffs are a good time to review and have a new pair of eyes evaluate the situation for both safety and quality.
Handoff is one of the TeamSTEPPS communication skills.
Robert Wachter’s book, Internal Bleeding, provides a thought provoking look at the general topic of handoffs in the chapter called "Handoffs and Fumbles."
Using the CUS technique provides a framework for conflict resolution, advocacy, and mutual support. When used, all team members will understand clearly not only the issue but also the magnitude of the issue.
2. Then state why you are uncomfortable
3. If the conflict is not resolved, state that there is a safety issue
4. If the safety issue is not acknowledged, a supervisor should be notified.
CUS is one of the TeamSTEPPS communication skills. Remember the video example from the in-person training?
Nurse: “Dr. Dean, I’m concerned about Mrs. Keys, the baby’s heart rate is in the 60s. I’m uncomfortable with these late decelerations and I don’t think it’s safe to continue labor.”
If CUS doesn’t work you can always try the John Wayne approach, as seen is this video clip from the movie The High and Mighty.