SBAR is a communication format used in healthcare to convey important information in a consistent, concise, clear, and effective way. It was originally utilized by the U.S. military in the 1940s in environments where effective communication was essential for safety (such as nuclear submarines!). Since then, SBAR has been adopted by the healthcare industry where it plays an important role in patient safety.
Unfortunately poor communication has been shown by the Joint Commision to be a contributing factor in more than 60% of adverse events in the clinical setting. Adverse events are defined as injuries caused by medical conduct that result in disability or increased length of stay. To help alleviate this and prevent errors, SBAR has become a standard communication format that can be utilized in a variety of situations to help ensure patient safety.
When is SBAR used?
SBAR is generally used in two key ways – when communicating critical information to the physician or other members of the healthcare team and when giving handoff report to another nurse.
Reasons to notify a physician are numerous and include changes in patient condition, parameters specified by the physician (such as abnormal vital signs), and when advocating for a patient need that has not yet been met. For example:
- Patient condition – You call the MD to report that the patient has a large amount of fresh blood in their stool.
- Notification parameters – The MD has written an order to be notified if the systolic blood pressure is < 90 and your patient’s SBP is 86/53.
- Advocacy – The patient has Parkinson’s disease but the physician has not ordered the patient’s usual dose of carbidopa-levodopa. You call the MD to advocate for this medication as you know that a delay in treatment can be detrimental and cause worsening of symptoms.
SBAR is also used for handoff report which can occur at the end of a shift and between phases of care, such as when the patient is transferred from one department to another. A great example of this is the patient who is transferred from the PACU to a room on a Med/Surg unit or when the patient is taken to another department for a procedure such as surgery or an endoscopy.
What does SBAR mean?
The letters in SBAR stand for situation, background, assessment, and recommendation. Because SBAR differs slightly in how it is utilized, two examples are provided below. One example looks at using SBAR to call a physician and the other shows how SBAR is used to give handoff report.
Using SBAR to call a physician
|Situation: This is a brief overview of what is going on with the patient and quickly conveys why you are calling. Your goal here is to get the other person’s attention. Think of this as the headline in a newspaper article. Key information to include here is your name and department, the patient’s name, where the patient is located (such as room number) and a brief description of the situation.
|Example: Hi Dr. Oliver. This is Maureen on the cardiac care unit. I’m calling about patient Robinson in 5310. She’s complaining of intense, crushing chest pain.
|Background: In this section, you describe the background as it pertains to this patient and the situation. This is not where you tell the doctor that the patient has had their foot amputated, unless of course, it contributes to the situation. Elements to include here are the patient’s primary diagnosis and any secondary medical conditions that may be contributing.
|Example: She was admitted yesterday for palpitations and a syncopal episode. She has a history of atrial fibrillation, coronary artery disease, and a prior MI.
|Assessment: When conveying your assessment of the situation you are providing additional data related to the patient’s problem. This can include relevant vital signs, lab values, and any physical assessment data you have obtained. It may also be a summation of what you think the problem is (though be careful that you aren’t diagnosing…that’s the MD’s job!)
|Example: Her heart rate is 136 and irregular, blood pressure has dropped twenty points from her baseline and is now 94/62. She’s diaphoretic and complaining of shortness of breath. She states the pain is a 10/10 that radiates to her jaw. I’m concerned she’s having an MI.
|Recommendation: This is where you advocate for what you think the patient needs. In other words, what is the next step in addressing this problem? Sometimes you will have specific requests, and other times, you simply need the MD to come see the patient.
|Example: I am requesting you come see this patient as soon as possible. In the meantime, would you like a 12-lead EKG and cardiac enzymes?
Pro tips for calling the MD
Calling the MD (or NP or PA) can be intimidating at first, but with these tips you’ll feel a lot more confident.
- Write out your SBAR before you call to ensure you don’t forget any important information. And if you’re especially nervous, ask a trusted coworker or mentor to go over it with you before you pick up the phone.
- Anticipate the doctor’s questions and have that information readily available. This could include lab results, urine output, and other assessment findings.
- Speak with confidence and stay on track.
- Don’t take it personally if the other person is abrupt with you. Physicians are pulled in a million different directions at once and phone calls from other members of the healthcare team are generally dealt with quickly and efficiently.
- Also, don’t take it personally if the person you are calling is downright rude (and yes, this does happen). Remember that it’s not about you and someone else’s unprofessional behavior is no reflection on you. You are doing your job as the patient advocate regardless of how the other person reacts.
- Repeat back any verbal orders given over the phone. This ensures you clearly understand what the MD is ordering.
- If the MD doesn’t provide any orders and isn’t coming to see the patient, ask them if they would like a follow-up call if the patient’s condition persists. Sometimes they’ll say no and other times they may give you specific parameters for a follow-up call. Be sure you write these as physician orders taken verbally over the phone.
- Be sure to say thank you, regardless of the other person’s demeanor. One thing we can always do is choose kindness, and I like to think that kindness can have a positive ripple effect. It’s free, it’s easy, and it helps you stay in a positive mindset.
Using SBAR to give handoff report
Situation: This is a brief overview of the patient’s current situation and includes elements such as the patient’s name, age, admission date, primary diagnosis, and any key highlights from their hospitalization (such as surgeries or a period in the ICU).
Background: In this element of your handoff report, include the patient’s relevant past medical history. Include items that pertain to the patient’s current diagnosis and any chronic conditions that will need to be managed. For example, the patient may have been admitted for pneumonia, but if they also have diabetes or hypertension, you’ll be managing those conditions as well.
Assessment: This is where you go head-to-toe and share pertinent information and any abnormal findings.
Recommendation: In this section, you are working to progress the patient’s care. List things that the patient needs in order to meet their goals. For example, do they need to have a bowel movement today, increase mobility, or transition to PO medications?
For more tips on giving an excellent end-of-shift report, check out one of my very first podcast episodes.
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Review how to communicate with SBAR on the go by tuning in to episode 328 of the Straight A Nursing podcast. Listen from any podcast platform, or straight from the website here.
The information, including but not limited to, audio, video, text, and graphics contained on this website are for educational purposes only. No content on this website is intended to guide nursing practice and does not supersede any individual healthcare provider’s scope of practice or any nursing school curriculum. Additionally, no content on this website is intended to be a substitute for professional medical advice, diagnosis or treatment.
Kaiser Permanente. (n.d.). Patient Safety Essentials Toolkit: SBAR: Situation-BackgroundAssessment-Recommendation. Institute for Healthcare Improvement. https://www.ihi.org/sites/default/files/SafetyToolkit_SBAR.pdf
Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ Open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202
Podgorny, K., & ASQ Quality Management Division. (n.d.). SBAR | ASQ. American Society for Quality. https://asq.org/quality-resources/sbar