SBAR stands for Situation, Background, Assessment, and Recommendation. It’s a structured communication framework that organizes critical information into four clear sections, making it easier to hand off patient details quickly and accurately. Originally developed for use in the U.S. Navy’s submarine program, SBAR was adopted by healthcare organizations as a way to reduce the kind of miscommunication that leads to medical errors. One study in an anesthetic clinic found that after implementing SBAR, incident reports caused by communication errors dropped from 31% to 11% within a single year.
Whether you’re a nursing student learning the format for the first time or a working clinician looking to sharpen your handoffs, here’s how to write each section effectively.
S: Situation
The Situation section answers one question: what is happening right now? This is your opening statement, and it should take no more than two or three sentences. Include the patient’s name, their location (unit, room number), your name and role, and the specific reason you’re communicating. Be direct about the problem.
For example: “I’m calling about Mrs. Chen in Room 412. She’s a 68-year-old patient who is two days post-hip replacement, and her blood pressure has dropped significantly in the last hour.” The goal is to immediately orient the person receiving the information so they know who, where, and why.
A common mistake here is burying the concern under too much context. Don’t start with the patient’s full medical history. Lead with the problem, because that’s what determines how urgently the listener needs to pay attention.
B: Background
Background provides the clinical context that makes the current situation meaningful. This is where you include the patient’s relevant medical history, the reason for admission, and any pertinent details like recent test results, lab values, imaging findings, or current medications. According to the Agency for Healthcare Research and Quality, the Background section should cover the patient history related to the current situation, signs and symptoms of the presenting complaint, and any supporting test results.
The key word is “relevant.” You’re not reciting the patient’s entire chart. If you’re calling about a sudden drop in blood pressure, the listener needs to know the patient’s baseline vitals, whether they’re on blood pressure medications, recent fluid intake, and any procedures that may have caused blood loss. They don’t need the patient’s allergy to shellfish unless it’s connected to the current problem.
Think of Background as giving the listener just enough history to understand why the current situation matters and what might be causing it.
A: Assessment
Assessment is where you share your professional analysis of the situation. The Institute for Healthcare Improvement describes this section as “what you found and what you think.” This is not just a list of vital signs. It’s your clinical interpretation of the data.
You might say: “Her blood pressure is 88/52, down from 120/78 this morning. Heart rate is 104. She’s pale and reporting dizziness. I think she may be bleeding internally from the surgical site.” You’re combining objective findings (the numbers) with your professional judgment (what those numbers suggest).
This section is where many people hesitate, especially newer clinicians who feel uncertain about stating an opinion to a more senior provider. But the Assessment is what makes SBAR more than a data dump. You are the person at the bedside, and your impression of the patient carries real weight. Even if you’re unsure, framing your assessment as “I’m concerned this could be X” is far more useful than simply listing numbers and leaving the interpretation to someone who hasn’t seen the patient.
R: Recommendation
Recommendation is the action step. You’re telling the listener what you think should happen next, or explicitly asking for a decision. This section should be specific and actionable.
Strong recommendations sound like: “I’d like you to come evaluate the patient within the next 30 minutes” or “Can we order a stat hemoglobin and type-and-cross?” or “I recommend we increase her IV fluid rate and recheck vitals in 15 minutes.” Weak recommendations sound like: “Just wanted to let you know” or “What do you want to do?” without offering any direction.
Even if you don’t have the authority to make the final call, proposing a specific next step moves the conversation forward. It also gives the receiving provider something concrete to agree with, modify, or redirect. If you’re genuinely unsure what to recommend, it’s appropriate to say so directly: “I’m not sure what the best next step is, but I think this patient needs to be seen soon.”
Putting It All Together
A complete SBAR might take 60 to 90 seconds when spoken aloud. Here’s how the full example flows:
- Situation: “I’m Sarah, the night nurse on the orthopedic unit. I’m calling about Mrs. Chen in Room 412, who is two days post-hip replacement. Her blood pressure has dropped significantly.”
- Background: “She was admitted Monday for a right hip replacement. Surgery was uncomplicated. Her baseline BP has been around 120/78. She’s on a low-dose blood thinner for clot prevention. No significant bleeding noted until this shift.”
- Assessment: “Her current BP is 88/52, heart rate is 104. She’s pale, lightheaded, and her surgical dressing has new saturation. I’m concerned about post-operative bleeding.”
- Recommendation: “I’d like you to evaluate her tonight. In the meantime, can I increase her IV fluid rate and order a stat hemoglobin?”
Notice how each section builds on the previous one. The Situation creates urgency, the Background adds context, the Assessment provides interpretation, and the Recommendation drives action.
Written vs. Verbal SBAR
SBAR works for both phone calls and written documentation. For shift handoffs, many units use printed or electronic SBAR templates that nurses fill out before handing off patients to the next team. The written version follows the same four sections but can include more detail, like specific medication dosages or a timeline of events during the shift.
For verbal communication, especially urgent phone calls, brevity matters more. Rehearse your SBAR before picking up the phone. Jot down the key points for each section so you don’t lose your place or wander into irrelevant details. Having vital signs, recent labs, and the patient’s medication list in front of you prevents the awkward pause of flipping through a chart mid-conversation.
The ISBAR Variation
Some organizations use ISBAR, which adds an “Identify” step before Situation. The I stands for identification of both the communicator and the patient, including details like full name, date of birth, and medical record number. This is particularly useful during phone handoffs or transfers between facilities where the receiving provider may not already have the patient’s chart open. SA Health in Australia, for example, uses ISBAR as its standard handoff tool and recommends adapting it to fit the clinical context.
If your organization uses ISBAR, treat the Identify step as a brief verification. It takes five seconds and prevents the kind of wrong-patient errors that standardized communication is designed to eliminate.
Why SBAR Works
Healthcare handoffs are inherently risky. The Joint Commission established a National Patient Safety Goal addressing handoff communication in 2006, later converting it to a formal standard requiring that handoffs include an illness assessment, patient summary, action list, and contingency plans, delivered face-to-face whenever possible. A Sentinel Event Alert followed in 2017 to reinforce the importance of high-quality handoffs. The Joint Commission doesn’t mandate SBAR specifically, but SBAR naturally covers all of these required elements.
The BMJ Open study that tracked SBAR implementation in an anesthetic clinic found statistically significant improvements in both communication accuracy between groups and overall safety climate. The drop in communication-related incidents, from 31% to 11%, wasn’t driven by people reporting fewer problems. Total incident reports actually increased (from 116 to 208), suggesting that staff became more vigilant overall while the proportion caused by miscommunication shrank dramatically.
Common Mistakes to Avoid
The most frequent problem with SBAR is skipping or weakening the Recommendation. Many clinicians, particularly those earlier in their careers, are comfortable reporting data but uncomfortable proposing a course of action. This turns the SBAR into an SBA, which puts the entire burden of decision-making on the receiver without the benefit of bedside insight.
Another common pitfall is overloading the Background section. When you include every detail from the patient’s chart, you dilute the urgency of the Situation and force the listener to filter for relevance. Keep Background focused on what connects to the current problem.
Some practitioners also blend sections together, jumping between Assessment and Background or circling back to add Situation details after they’ve moved on. Sticking to the linear structure, even if it feels rigid at first, is what makes SBAR reliable. Each section has a job. Let it do that job, then move on to the next.