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Closing the loop: a process evaluation of inpatient care team communication
  1. Kristy Kummerow Broman1,2,
  2. Clark Kensinger1,
  3. Heather Hart3,
  4. Jason Mathisen4,
  5. Sunil Kripalani5,6
  1. 1Division of General Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2GRECC, TVHS Nashville VA, Nashville, Tennessee, USA
  3. 3School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
  4. 4Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  5. 5Section of Hospital Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  6. 6Center for Clinical Quality and Implementation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Dr Kristy Kummerow Broman, Division of General Surgery, Vanderbilt University Medical Center, 1161 Medical Center Drive, D-5203 MCN, VUMC Nashville, Tennessee 37232, USA; kristy.l.kummerow{at}

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Interprofessional communication is a core component of healthcare delivery in inpatient settings and a key contributor to safe and efficient inpatient care. Communication is implicated in two-thirds of medical errors and accounts for a significant proportion of nurse and clinician time.1–4 Inpatient teams rely on multiple communication methods ranging from paging and stationary telephones to wireless mobile devices, but comparative evaluations of communication systems are largely limited to qualitative outcomes.5–10 With respect to safety and efficiency, key measures of communication system performance include frequency of task disruption and reliability of ‘closed loop’ communication, meaning the sender receives a sufficient response to address the communication need. We sought to understand communication processes in two different patient care areas of a single hospital using traditional (non-mobile) versus mobile phones and to quantify how each mode of communication affects task disruption, efficiency and reliability of closed-loop communication.


Our interprofessional team of providers, nurses and administrative leaders mapped processes for nurse-to-provider communication on two types of medical and surgical units that use different communication systems at Vanderbilt University Medical Center, a southeastern US academic medical centre. In both settings, nurses initiated messages by sending alphanumeric pages to clinicians. In the traditional (non-mobile) setting, providers called back a stationary unit phone, typically answered by the unit medical receptionist, who then located the nurse to answer the phone. In the …

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  • Contributors Study concept and design, acquisition, analysis or interpretation of data, and critical revision of the manuscript for important intellectual content: all authors. Drafting of the manuscript: KKB, CK and SK. Statistical analysis: KKB and JM. Study supervision: SK.

  • Funding US Department of Veterans Affairs.

  • Competing interests None declared.

  • Ethics approval Vanderbilt University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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