SBAR

SBAR is an acronym for Situation, Background, Assessment, Recommendation; a technique that can be used to facilitate prompt and appropriate communication. This communication model has gained popularity in healthcare settings, especially amongst professions such as nursing. It is a way for health care professionals to communicate effectively with one another, and also allows for important information to be transferred accurately. The format of SBAR allows for short, organized and predictable flow of information between professionals.[1]

History

Kaiser Permanente Building

SBAR was first developed by the military,[2] specifically the nuclear submarine industry. It was then used in the aviation industry, which adopted a similar model before it was put into use in health care. It was introduced to rapid response teams (RRT) at Kaiser Permanente in Colorado in 2002 , to investigate patient safety. The main purpose was to alleviate communication problems traced from the differences in communication styles between healthcare professionals.[2] SBAR was later adopted by many other health care organizations. It is among the most popular handover mnemonic systems in use.[3]

It is now widely recommended in healthcare communication. For instance, the Royal College of Physicians of London, UK, recommends the use of SBAR during the handover of care between medical teams when treating patients who are seriously ill or at risk of deteriorating.[4] SBAR is an included tool in the Interventions to Reduce Acute Care Transfers (INTERACT II) project, a US measure to reduce rehospitalization among residents of long-term care (LTC) facilities.[5]

Elements

Situation

This part of SBAR determines what is going on and why health care professionals are needed. Health care professionals become familiar with the environment and the patient. Identify the problem and concern and provide a brief description of it. Be able to describe what is going on with the patient and why they are experiencing what is going on.[6] During this stage of the communication the main goal is to communicate what is happening.[1] It is recommended that this element be brief and last no more than 10 seconds.[2]

It is recommended that health care professionals identify the person with whom they are speaking, to introduce oneself (including title or role) and where one is calling from. Providing information about the patient such as name, age, sex, and reason for admission is also important. Lastly, the health care professional is to communicate the patient's status (such as chest pain or nausea).[2]

Background

The goal of background is to be able to identify and provide the diagnosis or reason for the patient’s admission, their medical status, and history. As well as to determine the background or context of the patient's visit.[1][2] During this stage the patient's chart is ready and as much important medical-based information is provided to set up the assessment of data.[6]

Assessment

At this stage, the situation is surveyed to determine the most appropriate course of action.[1] Medically based aspects of the patient are to be provided at this time such as vital signs, recent labs and other quantitative or qualitative data that might be available. If a diagnosis has already been made, this is provided; alternatively, the temporary diagnosis is mentioned (while keep sure that adequate empathy and concern towards the patient are exhibited).[6] Any impertinent information is avoided unless asked for.[2]

At this stage, vital signs outside of normal parameters are specifically mentioned, as well as the health care professional's clinical impression of the severity of the patient's status and additional concerns.[2]

Recommendation

Health care professionals give very precise and descriptive explanations on exactly what they need during that time frame.[6] Possible solutions that could correct the situation at hand are discussed between health care professionals.[1] Notably, suggesting ideas to physicians can be a weak point of nurses.[2] Therefore, an explicit statement of what is required, how urgent, and what action needs to be taken is paramount.[2]

Preparation is an integral part of SBAR and health care professionals are suggested to prepare to be able to answer any question the physician may ask. Discussion with another colleague may help. It is highly recommended that information about medical records, medication, administration records, and patient flow sheet be studied before contacting a physician.[2]

Example of use in clinical setting

This is a direct example that shows how SBAR communication is used in a hospital setting involving communication between two nurses to effectively assess and diagnose the patient and correct the problem. This example is between an preoperative nurse to operating room nurse.[7]

Situation: "Mary, I'm going to be sending Mrs. Porter over to you in a few minutes for repair of her fractured ankle. I want you to know what's going on with her. I'm concerned about her emotional status. I've also alerted Dr Anesthesiologist and Dr Surgeon about my concern, but they have agreed to go ahead with the surgery because she needs this procedure to salvage her foot."

Background: "She was in an auto accident last Friday, and her husband was killed. Her children are all at the funeral home making arrangements for his burial. She's made some comments about not wanting to live. Her vital signs are stable; the foot is cool and slightly mottled. We've just given her some Versed."

Assessment: "I think her emotional status is such that this will be a very difficult period of time for her, especially during induction and awakening from anesthesia."

Recommendation: "I suggest that you meet her as soon as possible and stay with her during induction and emergence from anesthesia."

Effects of use

In a 2013 review of studies addressing communication errors during handover, the greatest problem reported was the omission of detailed patient information. SBAR has been suggested as a means to overcome this problem by applying a system and structure to the presentation of information.[8]

Using the SBAR communication model provides for more effective and enhanced family and patient outcomes on pediatric units. Using SBAR when producing bedside reports increases patient and family satisfaction and also increases their level of comfort when dealing with outlying situations. SBAR also allows nurses to be more effective when giving reports outside of the patients room. SBAR is a model used in communication that standardizes information to be given and lessons on communication variability, making report concise, objective and relevant.[9]

Another benefit of using SBAR is that it allows patients to have the time to ask any questions that they might have, and allows patients to gain exact knowledge of information related to their plan of care. SBAR allows patients to be fully aware of whom their nurse is on every shift and this adds to the patients sense of comfort knowing that there will always be someone around looking after them during shift change.[9]

SBAR use has not only improved the relationship between the doctors and the nurses but has also had a dramatic increase of overall health of patients. This led to a decrease in hospitalizations and deaths which efficiently improved communication between the nurse and doctor, which also led to a reduction of unexpected deaths. The problem between the communication between nurses and doctors is that the levels of teamwork and interaction are different therefore causing ineffective communication.[10]

SBAR has been used in quality improvement projects that have looked at ways of avoiding hospitalizations.[10]

Limitations

SBAR communication encounters difficulties in certain situations which are:

References

  1. 1 2 3 4 5 Thomas, Cynthia M.; Bertram, Evelyn; Johnson, Doreen (July 2009). "The SBAR Communication Technique". Nurse Educator. 34 (4): 176–180. doi:10.1097/NNE.0b013e3181aaba54. PMID 19574858.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 Pope, BB; Rodzen, L; Spross, G (March 2008). "Raising the SBAR: how better communication improves patient outcomes.". Nursing. 38 (3): 41–3. doi:10.1097/01.NURSE.0000312625.74434.e8. PMID 18418180.
  3. ↑ Riesenberg, L. A.; Leitzsch, J.; Little, B. W. (2009). "Systematic review of handoff mnemonics literature". American Journal of Medical Quality. 24 (3): 196–204. doi:10.1177/1062860609332512. PMID 19269930.
  4. ↑ "Acute care toolkit 6: the medical patient at risk: recognition and care of the seriously ill or deteriorating medical patient" (PDF). Royal College of Physicians of London. May 2013.
  5. ↑ Oakes, SL; Gillespie, SM; Ye, Y; Finley, M; Russell, M; Patel, NK; et al. (2011). "Transitional care of the long-term care patient". Clinics in Geriatric Medicine. 27 (2): 259–271. doi:10.1016/j.cger.2011.02.004. ISSN 0749-0690.
  6. 1 2 3 4 Dunsford, Jennifer (October 2009). "Structured Communication: Improving Patient Safety with SBAR". Nursing for Women's Health. 13 (5): 384–390. doi:10.1111/j.1751-486X.2009.01456.x. PMID 19821914.
  7. 1 2 Groah, L (April 2006). "Tips for introducing SBAR in the OR.". OR Manager. 22 (4): 12. PMID 16683480.
  8. ↑ Flemming, Daniel; Hübner, Ursula (2013). "How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review". International Journal of Medical Informatics. 82 (7): 580–592. doi:10.1016/j.ijmedinf.2013.03.004.
  9. 1 2 3 4 5 Novak, Kathleen; Fairchild, Roseanne (December 2012). "Bedside Reporting and SBAR: Improving Patient Communication and Satisfaction". Journal of Pediatric Nursing. 27 (6): 760–762. doi:10.1016/j.pedn.2012.09.001. PMID 23036598.
  10. 1 2 Narayan, MC (October 2013). "Using SBAR communications in efforts to prevent patient rehospitalizations.". Home Healthcare Nurse. 31 (9): 504–15; quiz 515–7. doi:10.1097/NHH.0b013e3182a87711. PMID 24081133.

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