11/13/24, 8\:20 PM Guide | SBAR

SBAR

Table of contents

What is SBAR?

SBAR (situation, background, assessment, recommendation) was designed as a communication tool to convey critical
information requiring immediate action and advice.
It has been adopted widely in healthcare settings as a structured method of communicating important clinical information (e.g.
escalation of care, patient handover).
This guide will cover how to use SBAR to communicate information. SBAR may be assessed in an OSCE as an individual skill, as
part of a history taking station or following an ABCDE assessment.

Key points when using SBAR

1. Ensure you have all the information before using SBAR (e.g. patient's notes, investigation results, observation charts). If
everything is electronic, ensure you are logged in with the relevant data open.
2. Stay calm even if the person on the other end of the phone is distracted or unhelpful. Being polite will get you much further,
and a ‘thank you’ at the end of the conversation is always appreciated.
3. Don't feel worried about asking a colleague for advice. Remember you are doing so to ensure high-quality patient care. If
you
when you tried to contact them. You can then seek advice from other senior members of your team.
4. The breadth and depth of information you communicate should change depending on the situation and clinical context.
You should choose the points from each section relevant to the clinical scenario. Only include relevant clinical details when
using SBAR. A common mistake is to overload the person receiving the handover with too much information.
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The SBAR communication tool

Situation

The situation section of SBAR involves a brief couple of sentences that should quickly inform the speaker about the current
situation requiring discussion.
Who
Introduce yourself, including your name and grade.
Clarify the name and grade of the person you are speaking to.
Provide the basic details of the patient you are calling about (e.g. name, gender, date of birth and hospital number).
Where
Provide the patient's location (e.g.
location if di
" T h e p a t i e n t i s l o c a t e d o n t h e h a e m a t o l o g y w a r d a t t h e R o y a l H o s p i t a l" ) and your own
When
Provide the timing of the current problem (e.g.
" T h e p a t i e n t b e g a n t o d e t e r i o r a t e 1 5 m i n u t e s a g o" )
What and why
Make it very clear what aspect of the patient's management you need advice on and explain your current working diagnosis
if relevant (e.g.
" I n e e d y o u r a d v i c e o n h o w w e s h o u l d m a n a ge t h e i n t r a c e r e b r a l h a e m o r r h a g e .
" ).
If there have been decisions about the escalation of care and resuscitation, these should also be discussed.
Example
" H e l l o , I’ m D a v i d , a j u n i o r d o c t o r c a l l i n g f r o m t h e e m e r ge n c y d e p a r t m e n t . C a n I a s k w h o I’ m s p e a k i n g t o ? ...
”
“ I’ m c a l l i n g a b o u t a p a t i e n t c a l l e d J a n e D o e ( D O B , p a t i e n t i d e n t i
m i n u t e s a g o w i t h a s u s p e c t e d i n t r a c e r e b r a l h a e m o r r h a ge . I’ d l i k e y o u t o r e v i e w t h e p a t i e n t .
"
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Background

The background section of SBAR involves providing an overview of the patient, including the relevant medical details.
Relevant medical details may include\:
Admission reason
Date of admission
Current diagnosis
Relevant past medical and surgical history
Relevant medications (e.g. warfarin if the patient has presented with a bleed)
Allergies (particularly if the allergy may impact the choice of treatment)
Relevant investigation results
Current management and the patient's clinical response
Example
“ M r s D o e p r e s e n t e d w i t h a c u t e o n s e t d y s a r t h r i a , l e f t-s i d e d l i m b w e a k n e s s a n d i n a t t e n t i o n . H e r p a s t m e d i c a l h i s t o r y
i n c l u d e s a T I A i n A u g u s t 2 0 1 7 , h y p e r c h o l e s t e r o l a e m i a a n d a t r i a l
a d m i s s i o n I N R i s 4 .8 . A C T h e a d d e m o n s t r a t e s a n i n t r a c e r e b r a l h a e m o r r h a ge i n t h e r i gh t h e m i s p h e r e w i t h s o m e
a s s o c i a t e d m a s s e
b e c o m i n g m o r e d r o w s y .
"

Assessment

The assessment part of SBAR involves communicating your objective clinical assessment of the patient including\:
Vital signs\: blood pressure, pulse, respiratory rate, SPO 2
and temperature
Clinical examination
be useful to provide a coherent structure
Overall clinical impression\: this is your working diagnosis (e.g. " t h e p a t i e n t a p p e a r s s e p t i c" " t h e p a t i e n t i s n e u r o l o gi c a l l y
d e t e r i o r a t i n g ")
Example
" T h e p a t i e n t c u r r e n t l y h a s a N E W S s c o r e o f 7 d u e t o b e i n g b r a d y c a r d i c a t 4 8 b p m , h y p e r t e n s i v e w i t h a B P o f 2 2 2 / 1 1 0 a n d
o n l y r e s p o n s i v e t o p a i n . R e s p i r a t o r y r a t e a n d o x y g e n s a t u r a t i o n s a r e c u r r e n t l y w i t h i n n o r m a l l i m i t s .
"
" O n a s s e s s m e n t , h e r a i r w a y i s n o t c u r r e n t l y c o m p r o m i s e d , t h e r e i s b i l a t e r a l a i r e n t r y o n t h e c h e s t w i t h n o a d d e d s o u n d s .
H e r p u l s e i s i r r e g u l a r , w i t h a r a t e o f 4 8 b e a t s p e r m i n u t e . N e u r o l o gi c a l e x a m i n a t i o n r e v e a l s d e n s e l e f t-s i d e d w e a k n e s s a n d
a G C S o f 1 1 w h i c h h a s f a l l e n f r o m h e r a r r i v a l G C S o f 1 4 . C a p i l l a r y b l o o d gl u c o s e i s 7 . T h e r e i s n o e x t e r n a l e v i d e n c e o f h e a d
i n j u r y a n d t h e r e i s n o v i s i b l e r a s h .
"
" T h e p a t i e n t a p p e a r s t o b e n e u r o l o g i c a l l y d e t e r i o r a t i n g , r e s u l t o f t h e i n t r a c e r e b r a l h a e m o r r h a ge .
"
m o s t l i k e l y s e c o n d a r y t o i n c r e a s e d i n t r a c r a n i a l p r e s s u r e a s a

Recommendation

The recommendation section of SBAR includes both your recommendations for what you believe the next most appropriate
steps in management should be and asking what the person on the phone would recommend.
State the following
State your suspected diagnosis, what you think needs to happen and in what time frame you expect those things to happen.
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" T h i s l a d y h a s s u
r e v i e w b y t h e n e u r o s u r g i c a l t e a m .
"
Ask the following
Whether they can review the patient and in what time frame they could do this.
Whether there is anything further you could do (e.g. requesting investigations, administering treatments).
Whether a transfer to another clinical environment is required (e.g. ward, theatre, ICU).
" A r e y o u a b l e t o c o m e a n d r e v i e w t h e p a t i e n t n o w ? I n t h e m e a n t i m e a r e t h e r e a n y o t h e r t r e a t m e n t s o r i n v e s t i ga t i o n s y o u' d
s u g g e s t ? A r e y o u h a p p y t o a c c e p t t h i s p a t i e n t f o r t r a n s f e r u r ge n t l y t o t h e n e u r o s u r gi c a l h i g h-d e p e n d e n c y u n i t ?"
If you're not sure what's happening
If you’re unsure of the diagnosis or management, you can say something like\:
p a t i e n t i s d e t e r i o r a t i n g” and then state how they are deteriorating. Or even,
c o n c e r n e d a n d w o u l d a p p r e c i a t e y o u r i n p u t”
.
“ I a m n o t s u r e w h a t t h e p r o b l e m i s , b u t t h e
“ I’ m n o t s u r e w h a t t h e p r o b l e m i s , b u t I’ m r e a l l y
Final steps
This
ask any further questions and allows you to clarify the expected response.
Check that they have accurately understood the current clinical situation and check if they have any further questions.
Clarify expectation of response (e.g.
" S o y o u' l l b e c o m i n g w i t h i n t h e n e x t 5 m i n u t e s t o r e v i e w t h e p a t i e n t ?" ).
Document the discussion in the patient's notes, including the details of those involved (name, grade, bleep, their advice and
timings).
Thank the person at the end of the conversation.
Source\: geekymedics.com
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