Section 1: Overview of Key Concepts and Tools

This section provides an overview of the key concepts and tools in the Communication Module. More explanations and illustrations are provided in section 2 of this module; methods for teaching the concepts and tools for this module are in section 3. Information about implementing the module's tools, including knowing whether an organization is ready for implementation, is provided in section 4.

Key Concepts

Communication

Communication is a verbal and nonverbal process by which information can be clearly and accurately exchanged among team members. Communication is one of the four essential skills central to highly reliable, safe, efficient, and patient-centered care.

The Transaction Model of Communication

The Transaction Model of Communication involves two or more people continuously sharing information with each other throughout their interaction to co-create meaning.¹

Communication Tools

SBAR

A technique for communicating critical information concerning the condition of a patient or another issue affecting the team that requires immediate attention and action.

Closed-Loop Communication

Using verbal feedback, including call-outs, check-backs, and teach-backs, to ensure that recipients correctly understand messages.

Call-Out

A strategy used to communicate important or critical information. Call-outs:

• Inform all team members simultaneously during situations.
• Help team members anticipate next steps.
• Direct responsibility by name to the specific individual responsible for carrying out the task.

Check-Back

A closed-loop communication strategy used to ensure that information shared by one team member is correctly understood by another team member.

Teach-Back

A method to confirm that you have explained information clearly and that patients, family caregivers have a clear understanding of what you have told them. In a teach-back, you ask the patient or family caregiver to explain the information they need to know or actions they need to take, in their own words.

Handoff

A standardized method for transferring information (along with authority and responsibility) during transitions in patient care.

A proper handoff includes the following:

• Transfer of responsibility and accountability. When handing off, it is your responsibility to know that the person who must accept responsibility is aware they are assuming responsibility. Similarly, you are accountable until the other party is aware of the transfer of responsibility.
• Clarity of information. When uncertainty exists, it is your responsibility to clear up all ambiguity about responsibility before the transfer is completed.
• Verbal communication of information. You must use appropriate communication channels and cannot assume that the person obtaining responsibility will read or understand the communication without confirmation.
• Acknowledgment by receiver. Until it is acknowledged that the handoff is understood and accepted, you cannot relinquish your responsibility. This step is particularly crucial for handoffs that occur electronically (e-handoffs).
• Opportunity to review. Handoffs are a good time to have a new pair of eyes evaluate the situation for both safety and quality.

I-PASS

I-PASS is the preferred handoff tool for patient transitions in care in many organizations.

Illness Severity

• Stable, "watcher," unstable

Patient Summary

• Summary statement
• Events leading up to admission or care transition
• Hospital course or treatment plan
• Ongoing assessment
• Contingency plan

Action List

• To-do list
• Timelines and ownership

Situation Awareness & Contingency Planning

• Know what’s going on
• Plan for what might happen

Synthesis by Receiver

• Receiver summarizes what was heard
• Asks questions
• Restates key actions/to-do items

Note

1. Lapum J, St-Amant O, Hughes M, Garmaise-Yee J, eds. Introduction to Communication in Nursing. Toronto, CA: Toronto Metropolitan University Pressbooks; 2020. Accessed April 26, 2023.