SBAR, which stands for Situation, Background, Assessment, and Recommendation, is a structured communication tool widely used in healthcare to standardize the transfer of information. Its primary goal is to enhance patient safety by ensuring that all communication concerning a patient’s condition is clear, concise, and complete. The framework was originally developed by the United States military and later adapted for healthcare use by Kaiser Permanente, becoming an endorsed standard by organizations like The Joint Commission. By organizing data into four distinct sections, SBAR helps reduce the risk of misunderstandings and information gaps that can lead to adverse events in clinical settings.
Reporting Critical Patient Status Changes
The most urgent application of the SBAR framework occurs when a patient experiences an acute change in status that demands immediate attention or intervention from another provider. This tool is designed to facilitate the rapid escalation of concern, ensuring the receiving clinician understands the gravity of the problem without delay. The structured format prevents the omission of important details, which is a common cause of communication failure during high-stress situations.
Specific triggers for using SBAR involve sudden physiological deterioration. These include significant shifts in vital signs, such as a systolic blood pressure dropping below 100 mmHg or rising above 200 mmHg, or a heart rate falling below 50 or exceeding 140 beats per minute. An acute change in respiratory status, like a respiratory rate less than 5 or greater than 40 breaths per minute, or a rapid drop in oxygen saturation, also warrants immediate SBAR communication.
Neurological changes, such as new-onset confusion, lethargy, or unresponsiveness, are clear indicators for utilizing this framework to call for help, such as a rapid response team. In the “Situation” component, the communicator identifies the patient and the specific problem, like “new onset chest pain.” The “Assessment” then includes the provider’s interpretation, stating clearly whether the patient is unstable or deteriorating, even if the exact diagnosis is unknown. Finally, the “Recommendation” requests a specific action, such as “come to see the patient now” or “transfer the patient to the Intensive Care Unit.”
Structured Communication During Handoffs
SBAR is routinely implemented during scheduled transitions of care, known as handoffs, where the responsibility for a patient shifts from one healthcare provider or team to another. Using SBAR during handoffs ensures a systematic transfer of all relevant clinical context, maintaining a shared understanding of the patient’s plan of care. This application of the tool is designed to prevent the loss of continuity that frequently occurs when staff members change.
A primary example is the nurse-to-nurse shift change, where the outgoing nurse uses the SBAR structure to brief the incoming nurse on each patient. The “Background” section is particularly useful here, covering the patient’s admitting diagnosis, medical history, and recent treatments or medications. This component provides the necessary context for the current “Situation,” such as the patient’s status at the moment of the handoff.
Transfers between different hospital units, such as moving a patient from the Emergency Department to a surgical floor, also require the use of SBAR. The framework ensures that the receiving unit is fully aware of any pending diagnostic tests, recent clinical events, or unresolved issues. By structuring the information, SBAR reduces the likelihood of crucial details being overlooked or minimized.
Framing Requests for Consultation
The SBAR structure is highly effective when a primary provider seeks input, advice, or a management plan from a specialist or consulting service. Using the framework to request a consultation provides the specialist with a concise, organized summary of the patient’s status, saving time and focusing the conversation.
The consultation request begins with the “Situation,” clearly stating the patient’s identity and the reason for the specialist’s involvement, such as “Patient X requires an urgent cardiology consult for new-onset atrial fibrillation.” The “Background” then supplies the specialist with relevant historical data, including comorbidities and any recent procedures that are pertinent to the current issue. This context is important for the specialist to understand the patient’s overall clinical picture.
The “Assessment” component allows the primary provider to share their initial interpretation, providing a working diagnosis or stating the problem as they perceive it. Finally, the “Recommendation” is used to clearly articulate the desired action from the consultant. This might be a specific request like “Please recommend a management plan for their new-onset seizure activity” or “Please advise on the appropriate antibiotic regimen,” ensuring the consulting service knows exactly what is expected of them.