The SBAR (Situation, Background, Assessment, Repeat-Back Recommendation/Request) communication tool is a structured method for conveying critical information succinctly and effectively, particularly in healthcare settings. Developed by the United States Navy and later adapted for healthcare, SBAR enhances communication among healthcare professionals, thereby improving patient safety and care quality. This discussion intends to provide a thorough understanding of the SBAR framework, its components, applications, and evidence supporting its effectiveness.
Situation
The "Situation" component of SBAR involves a clear and concise statement of the current issue or problem at hand.
This section should address the following questions:
- What is happening at the present moment?
- Who is involved?
- What is the urgency of the situation?
As an example of Situation, a paramedic might state: “Good afternoon Doctor, I am calling about a 65-year-old male patient who is experiencing severe chest pain and currently has an Early Warning Score of 5."
Background
The "Background" component should provide context for the situation by detailing relevant patient history and circumstances.
This includes:
- The patient's medical history.
- Recent changes in condition.
- Relevant treatments or interventions that have been administered.
Continuing with the previous example, the Background from the paramedic might state: “The patient has a history of coronary artery disease and had a stent placed for myocardial infarction 45 days ago. The patient was feeling fine until this morning when began experiencing sudden chest pain, which he is describing as 8 out of 10. The patient is on 10 mg Metoprolol BID, 10 mg Atorvastatin, and 81 mg Aspirin daily."
Assessment
During the "Assessment" component, the person giving the report shares their professional evaluation of the situation. This includes:
- Clinical findings.
- Vital signs.
- Any pertinent laboratory or diagnostic results.
Continuing the previous example, the paramedic might state: “On exam, 100kg, Alert to voice, GCS 14, MAP 53 mmHg (est. 80/40), Heart rate 110 bpm in sinus tachycardia with widened QRS, 12 Lead ECG shows STEMI in Lead II/Lead III/aVF, Respiratory rate 20 bpm, SpO2 92% on 15L O2 via NRB, EtCO2 34 mmHg with normal waveform, patient is diaphoretic, no peripheral edema, no JVD, trachea midline, lung sounds are clear bilaterally. FOCUS exam reveals IVC is collapsing greater than 50% and there is poor diastolic refilling. Patient appears to be an inferior wall MI with hypotension”
Repeat-Back Recommendation/Request
The final component, "Recommendation/Request," involves proposing a course of action based on the assessment. This should be specific and actionable. The person making the report should address:
- What actions have they taken thus far.
- What they believe should happen next.
- Any immediate interventions required.
- Suggestions for further evaluation or treatment.
Continuing the previous example, the paramedic might state: “We are enroute to your facility with a 20-minute transport time. Patient has received O2 via NRB and NC at 15l/min, 325mg Aspirin PO chewed, 16g IV in left antecubital fossa, 1000 ml Lactated Ringer’s thus far for preload, patient is in a gown with clothing removed, pulses are marked, groin is prepped, 5000u Heparin administered, and 100mg Ketamine administered over 3 minutes. Patient states pain is now a 3 on scale of 10.”
“if the fluid administration does not resolve hypotension to a goal of MAP of 65 mmHg, we will begin an addition fluid bolus after repeat FOCUS to assure fluid is appropriate, if not we will begin an Epinephrine infusion at 4-8mcg/min; if MAP raises above MAP 65 mmHg, we will begin Nitroglycerin Infusion at 50 mcg”
“Do you have any further suggestions or requests?”
Applications of SBAR
SBAR is widely utilized in various healthcare settings, including EMS, Aeromedical, hospitals, nursing homes, and outpatient clinics. Its applications extend to encompass interdisciplinary communication among physicians, midlevel practitioners, nurses, EMS providers, pharmacists, and allied health professionals.
The structured nature of SBAR facilitates:
- Hand-off Communication:
- Ensuring continuity of care during shift changes or patient transfers.
- Emergency Situations:
- Rapidly conveying critical information to expedite decision-making.
- Interdisciplinary Collaboration:
- Enhancing teamwork and reducing misunderstandings among healthcare providers.
SBAR is one of the most widely used tools for many reasons (AHRQ 2019):
- Structured communication tools such as SBAR can enhance communication between members of the healthcare team.
- SBAR provides a vehicle for individuals to speak up and express concern in a concise manner.
- SBAR is useful for framing any conversation, especially critical ones requiring a team's immediate attention and action, such as when a patient's condition is rapidly deteriorating. It may also be useful with providers who are not part of the core team, such as remote consultants or mental health providers.
Additional notes on using SBAR include:
- Do not forget to introduce yourself—you should not assume that everyone knows who you are. (AHRQ 2019)
- SBAR is adaptable. Think of it as a menu: the parts you choose to use and the order in which they are used depend on your team's unique needs. Determine which parts of SBAR are relevant to your team's needs and use those when communicating critical information among your team members. (AHRQ 2010)
- SBAR can be modified for use by the patient or family caregivers to communicate with the care team. For example, your facility could provide patients with a summary of SBAR to enable them to share information about their own situation, background, assessment, and recommendations or to ask the care team about their care. (AHRQ 2019)
- Consider saying the actual words to keep yourself on track: "The situation is..., The background is..., My assessment is…, I recommend..." (AHRQ 2019)
Evidence Supporting SBAR Effectiveness
Numerous studies have demonstrated the effectiveness of SBAR in improving communication and patient outcomes. One study showed improved communication (Henneman 2012) with improved clarity and completeness, which lead to decreased adverse events. Another study showed a significant decrease in medication errors and improved patient safety (Weaver 2013). Staff satisfaction improved through the use of SBAR, due to clear framework and decreased cognitive load on healthcare providers in communication (McFadden 2015).
In Summary
The SBAR communication tool is an invaluable asset in healthcare settings, promoting effective and efficient information exchange among professionals. By adhering to the structured format of Situation, Background, Assessment, and Recommendation, healthcare providers can enhance patient safety, improve clinical outcomes, and foster a culture of collaboration. Continued research and training in SBAR implementation are essential for maximizing its benefits in clinical practice.
References:
- Tool: SBAR. Content last reviewed November 2019. Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/sbar.html
- Henneman, E. A., et al. (2012). "The Effect of SBAR on Communication in Nursing: Systematic Review." Journal of Nursing Care Quality, 27(3), 231-238.
- Weaver, S. J., et al. (2013). "The Impact of SBAR on Patient Safety: A Systematic Review”. American Journal of Nursing, 113(2), 24-32.
- McFadden, K. L., et al. (2015). "The Impact of SBAR on Communication in Healthcare: A Systematic Review." Journal of Healthcare Management`, 60(2), 123-136.