Closed-loop communication during out-of-hospital resuscitation

Are the loops really closed?

Authors

  • Ernisa Marzuki Universiti Malaysia Sarawak, Malaysia, University of Edinburgh
  • Hannah Rohde University of Edinburgh
  • Chris Cummins University of Edinburgh
  • Holly Branigan University of Edinburgh
  • Gareth Clegg Royal Infirmary of Edinburgh, UK
  • Anna Crawford Royal Infirmary of Edinburgh, UK
  • Lisa MacInnes Queen’s Medical Research Institute, Edinburgh, UK

DOI:

https://doi.org/10.1558/cam.37034

Keywords:

closed-loop communication, dialogue annotation/dialogue coding, out-of-hospital cardiac arrest resuscitation, paramedic team communication

Abstract

Training for effective communication in high-stakes environments actively promotes targeted communicative strategies. One oft-recommended strategy is closed-loop communication (CLC), which emphasises three components to signal understanding: call-out, checkback and closing of the loop. Using CLC is suggested to improve clinical outcomes, but research indicates that medical practitioners do not always apply CLC in team communication. Our paper analyses a context in which speakers’ linguistic choices are guided by explicit recommendations during training, namely out-of-hospital cardiac arrest (OHCA) resuscitation. We examined 20 real-life OHCA resuscitations to determine whether paramedics adopt CLC in the critical first five minutes after the arrival of the designated team leader (a paramedic specially trained in handling OHCA resuscitation), and what other related communication strategies may be used. The findings revealed that the standard form of CLC was not consistently present in any of the resuscitations despite opportunities to use it. Instead, we found evidence of non-standard forms of CLC and closed-ended communication (containing the first two components of standard CLC). These findings may be representative of what happens when medical practitioners communicate in time-critical, real-life contexts where responses to directives can be immediately observed, and suggest that CLC may not always be necessary for effective communication in these contexts. 

Author Biographies

  • Ernisa Marzuki, Universiti Malaysia Sarawak, Malaysia, University of Edinburgh

    Ernisa Marzuki received her PhD in Linguistics and English Language from the University of Edinburgh. She is a Lecturer in the Faculty of Language and Communication Studies, Universiti Malaysia Sarawak, Malaysia. Her main interest is medical communication, particularly in areas involving linguistic features that can affect medical outcomes. 

  • Hannah Rohde, University of Edinburgh

    Hannah Rohde received her PhD in Linguistics from the University of California San Diego. She is currently a Reader in the Department of Linguistics and English Language, University of Edinburgh. Amongst other things, she is interested in the ways listeners infer pragmatic cues when faced with ambiguity in what they hear. 

  • Chris Cummins, University of Edinburgh

    Chris Cummins received his PhD in English and Applied Linguistics from the University of Cambridge, UK. He is a Reader in the Department of Linguistics and English Language, University of Edinburgh. His research is predominantly in experimental pragmatics and semantics, focusing on why speakers choose to use particular linguistic forms and how hearers interpret this.

  • Holly Branigan, University of Edinburgh

    Holly Branigan received her PhD in Cognitive Science from the University of Edinburgh. She is a Professor in the Department of Psychology and is also currently Head of the School of Philosophy, Psychology and Language Sciences, University of Edinburgh. Her main research interests are the psychology of communication and the relationship between linguistic and psychological theories of syntax. 

  • Gareth Clegg, Royal Infirmary of Edinburgh, UK

    Gareth Clegg is a Consultant in Emergency Medicine at the Royal Infirmary of Edinburgh and an Associate Medical Director at the Scottish Ambulance Service. He leads the Resuscitation Research Group at the University of Edinburgh. The group’s focus is the optimisation of pre-hospital resuscitation through a range of innovative approaches, and members are currently working with a range of partners in the emergency services, third sector and Scottish Government to implement a national strategy for out-of-hospital cardiac arrest management. 

  • Anna Crawford, Royal Infirmary of Edinburgh, UK

    Anna Crawford graduated as a medical doctor from the University of Edinburgh. She is a researcher in the Resuscitation Research Group, focusing on pre-hospital resuscitation. 

  • Lisa MacInnes, Queen’s Medical Research Institute, Edinburgh, UK

    Lisa MacInnes graduated with an MSc in Clinical Education from the University of Edinburgh. She is the Director of Save A Life for Scotland, a national campaign aiming to increase bystander CPR and pre-hospital cardiac arrest survival, and also the lead research nurse of the Resuscitation Research Group, Edinburgh. She is currently focusing on decision-making support for paramedics managing out-of-hospital cardiac arrests using live video streaming. 

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Published

2020-09-15

Issue

Section

Articles

How to Cite

Marzuki, E., Rohde, H., Cummins, C., Branigan, H., Clegg, G., Crawford, A., & MacInnes, L. (2020). Closed-loop communication during out-of-hospital resuscitation: Are the loops really closed?. Communication and Medicine, 16(1), 54–66. https://doi.org/10.1558/cam.37034

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