The habit I almost skipped
Early in my career, I used to think checklists and routines were for people who couldn’t keep things straight in their heads. I was wrong. The busier my days got, moving between hospitalist rounds, infectious disease consults, and pain management visits, the more I leaned on a few habits that had nothing to do with being smart and everything to do with being consistent.
I want to talk about one specific habit: closing the loop on every piece of pending information before I let myself call a day done.
What “closing the loop” actually means
It sounds simple. It is not always easy. Every day, patients have labs pending, cultures growing, imaging waiting to be read, or a specialist I asked to weigh in. It is tempting to trust that someone will call if something is wrong. Early on, I did trust that. I learned the hard way that silence is not the same as good news.
I had a case where I asked a nurse to call me back with lab results overnight. The call never came. I assumed no news meant stable news. The patient ended up in surgery the next day. Nothing about that sat well with me, and it changed how I practice.
Now I do not wait on results I have not confirmed. If I am expecting a value and I have not seen it by a certain point, I go find it. If I am worried about a patient and a specialist has not called back, I call again, or I consult someone else while I wait. I do not let a gap in communication become a gap in care.
Why this earns its place over other habits
I have tried a lot of routines over the years. Some stuck. Most did not. This one stuck because it solves a real problem instead of a hypothetical one. A lot of habits people recommend in health care are about efficiency: batching tasks, templating notes, that kind of thing. Those help, but they are not the difference between a patient doing well and a patient not doing well.
Closing the loop is different. It is a habit built entirely around the moment where things go wrong: information exists somewhere, but it has not reached the person who needs to act on it. That gap is where bad outcomes live. Not in the lack of knowledge. In the lack of follow-through on knowledge that already exists.
What it looks like day to day
For me, this is not a dramatic thing. It is small and repetitive:
- Before I leave a unit, I mentally run through every patient I touched and ask what I am still waiting on.
- If a specialist consult has not returned a call within a reasonable window, I follow up rather than assume it is handled.
- If a patient’s status changes even slightly, I do not wait for the next scheduled check-in to reassess.
None of this requires special training. It requires deciding, ahead of time, that “I asked for it” is not the same as “I have it.”
Why I think more people should build this habit
I think a lot of new providers, and honestly a lot of experienced ones, underestimate how much of patient safety comes down to follow-through rather than knowledge. You can know the right antibiotic, the right dose, the right differential, and still have a patient suffer because a result sat in a queue for six hours longer than it should have.
Patience and compassion get talked about a lot in nursing, and they matter. But there is a quieter quality that matters just as much: refusing to let care stall out while you wait for someone else to move it forward. That is not about being anxious or hovering. It is about treating every open loop as your responsibility until it is actually closed.
The trade-off worth naming
This habit costs something. It means more phone calls, more double-checking, more moments where you interrupt your own workflow to chase something down. Some of that chasing turns out to be unnecessary. The result was fine. The specialist was already on it. That is fine with me. I would rather make ten calls that did not need to happen than skip the one that did.
That is the whole habit, really. Assume nothing is finished until you have confirmed it yourself, and treat that confirmation as part of the job, not an extra step on top of it.