Communication using the SBAR tool, Patient Safety Team, NHS Improving Quality, more at http://www.nhsiq.nhs.uk/improvement-programmes/patient-safety.aspx

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Communication using the
SBAR Tool

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Aims and Objectives
• Communication failures often contribute to patient safety
incidents and harm
• Communication is about shared understanding of an
issue
• The SBAR tool is easy to use and remember
• The SBAR tool can be used for all forms of
communication

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Communication
… two-way process of reaching mutual
understanding, in which participants not only
exchange information but also create and
share meaning …

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Communication
• Verbal – face-to-face (1 to 1)
– Referral / handover / briefing
• Verbal – face-to-face (1 to group)
– Handover/ briefing
• Verbal - telephone (live)
– Referral / handover/ briefing/ question / advice
• Verbal – telephone (recorded message)
– Referral / question / advice
• Written – email
– Referral/ question / advice
• Written - letter
– Referral/ question / advice
• Written – report
– Update / interim report / final report
• Written – telephone message
• Emergency / urgent / non-urgent

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Communication and Patient Safety
• Significant proportion of patient safety incidents are the result of
communication failures:
– between healthcare professionals - clinical and non-clinical
– between healthcare staff and patients
• Communication failure results from;
– poor structure of message
– lack of planning
– lack of key information
– poor prioritisation
– desired result not achieved
JCAHO – communication failure is the leading cause of inadvertent patient harm (2004)

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Examples
• Nurse asks doctor to take blood from patient, bed 3 bay 1. Later
nurse asks all patients in bay 1 if they have had they pre-op bloods
taken. Patient in bed 3 says he has had bloods done twice.
• Manager talks to colleague about a project which has not been
completed on time. Colleague apologises and says he has had a
‘virus’. Manager assumes viral illness, colleague means a computer
virus.
• What examples can you think of?

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Communication in Healthcare
Handover
Continuity of care
Briefing
Sharing mental
models
Call for
help
Escalation of
concerns
• Roles and
responsibilities
• Chain of
command
• Assertiveness
• Preparing to act
• Sharing a plan
• Co-ordination of
effort
• Data
information and
insight
• Acceptance of
responsibility
• Point of transfer

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Attention Loop
Decreasing
Attention
Time
Transmission
Evaluating
Reflecting
Listening
Formulating
Response
Listening
Challenging or Unwelcome News

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Organising thoughts
• Prepare
– Why are you having the conversation ?
– What is the message?
– Ensure the receiver is ready
– How will you know if you have the right result?
• Precis
– Select the key issue (s)
– Provide sufficient additional information to provide context but remove
extraneous detail
– Use short sentences
– Avoid jargon
• Prioritise
– Put the key points first
– Clarify anything which might be ambiguous

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Delivery
• Who are you?
• Where are you ?
• Who are you talking to ?
• Big Hits
– Critical Information
• Big Picture
– Context and boundaries
• Relevant Detail
– Keep it short

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SBAR
• Many exchanges are not face-to-face so only the spoken / written word is
available.
• The person being called will respond only to what you say and they may
have limited time or capacity to deal with your concerns
• There may be no support from shared documents or images so the
language which you use must be clear and unambiguous.
• There may not be an established personal relationship between the person
calling for help and the person being called upon.
• The person taking the call may not be in a position to listen carefully, take
notes or give you their undivided attention when they first answer.

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What is SBAR?
• SBAR is a structured method for communicating critical information that
requires immediate attention and action
• SBAR improve communication, effective escalation and increased safety
• Its use is well established in many settings including the military, aviation
and some acute medical environments
• SBAR has 4 steps
– Situation
– Background
– Assessment
– Recommendation

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SBAR
Situation
What is happening now ?
Background
What has happened in the past that is relevant ?
Assessment
What is the problem / issue in your view ?
Recommendation
What do you think needs to happen now ?What does the receiver want you to
do ?

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© NHS Institute for Innovation and Improvement Safer Care
Why use SBAR?
• To reduce the barrier to effective communication across different
disciplines and levels of staff.
• SBAR creates a shared mental model around all patient handoffs
and situations requiring escalation, or critical exchange of
information (handovers)
• SBAR is memory prompt; easy to remember and encourages prior
preparation for communication
• SBAR reduces the incidence of missed communications

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How can SBAR help me?
• Easy to remember
• Clarifies what information needs
communicating quickly
• Points to action
Prevents “hinting and hoping”

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© NHS Institute for Innovation and Improvement Safer Care
Uses and Settings for SBAR
• Inpatient or outpatient
• Urgent or non urgent communications
• Conversations with a physician, either in person or over the phone
• - Particularly useful in nurse to doctor communications
- Also helpful in doctor to doctor consultation
• Discussions with allied health professionals
• - eg Respiratory therapy
- eg Physiotherapy
• Conversations with peers
• - eg Change of shift report
• Escalating a concern
• Handover from an ambulance crew to hospital staff

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Situation
• Identify yourself the site/unit you are calling from
• Identify the patient by name and the reason for your
report
• Describe your concern
• Firstly, describe the specific situation about which you
are calling, including the patient's name, consultant,
patient location, resuscitation status, and vital signs.
For example:
"This is Lou, a registered nurse on Nightingale Ward. The reason I'm calling is
that Mrs Taylor in room 225 has become suddenly short of breath, her oxygen
saturation has dropped to 88 per cent on room air, her respiration rate is 24
per minute, her heart rate is 110 and her blood pressure is 85/50.”

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Background
• Give the patient's reason for admission
• Explain significant medical history
• Overview of the patient's background: admitting diagnosis,
date of admission, prior procedures, current medications, allergies,
pertinent laboratory results and other relevant diagnostic results. For
this, you need to have collected information from the patient's chart,
flow sheets and progress notes.
For example:
"Mrs. Taylor is a 69-year-old woman who was admitted from home three days
ago with a community acquired chest infection. She has been on intravenous
antibiotics and appeared, until now, to be doing well. She is normally fit and
well and independent.”

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© NHS Institute for Innovation and Improvement Safer Care
Assessment
• Vital signs
• Clinical impressions, concerns
For example:
• You need to think critically when informing the doctor of your assessment of
the situation. This means that you have considered what might be the
underlying reason for your patient's condition.
• If you do not have an assessment, you may say:
"Mrs. Taylor’s vital signs have been stable from admission but deteriorated
suddenly. She is also complaining of chest pain and there appears to be blood
in her sputum. She has not been receiving any venous thromboembolism
prophylaxis.”
“I’m not sure what the problem is, but I am worried.”

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© NHS Institute for Innovation and Improvement Safer Care
Recommendation
• Explain what you need - be specific about request and timeframe
• Make suggestions
• Clarify expectations
• Finally, what is your recommendation? That is, what would you like
to happen by the end of the conversation with the physician? Any
order that is given on the phone needs to be repeated back to
ensure accuracy.
"Would you like me get a stat CXR? and ABGs? Start an IV? I would like you
to come immediately”

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• Incorporating SBAR may seem simple, but it
takes considerable training
• It can be very difficult to change the way people
communicate, particularly with senior staff
Summary

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Using SBAR
• Table Exercise and discussion