Poor communication amongst colleagues in a healthcare setting is often considered the root cause of complications when it comes to patient care. Miscommunication pertaining to a patient may lead to unwanted consequences such as a misdiagnosis or ineffective treatment.
This happens when critical information is omitted from interactions between healthcare practitioners which may come about due to various reasons. Differences in background, training, or communication styles will doubtlessly affect the way that information is relayed as well as received.
In a profession that constantly faces high stakes situations, where it could literally be a matter of life or death, mistakes borne from failures in communication simply cannot be afforded. Which is exactly why a streamlined means of communication like SBAR is so highly recommended in the medical field.
What is an SBAR?
So, what does SBAR stand for? SBAR’s medical abbreviation stands for Situation, Background, Assessment, and Recommendation.
SBAR was originally a method of communication developed by the United States military for the use of nuclear submarines. Since then it has branched into the fields of aviation, rapid response teams, and ultimately, healthcare.
It was first adapted by Kaiser Permanente in 2002 as a tool for its rapid response teams to investigate and ensure patient safety. They found that SBAR was an effective means of communication in terms of relaying pertinent information on the patient’s situation with minimal mistakes. Then in 2013, SBAR was endorsed by the Joint Commission and deemed the communication standard for nurses.
But what exactly is SBAR’s meaning in the medical field? It is the process by which a healthcare professional conveys information related to their patient while maximizing efficiency and accuracy. The table below expounds on its definition and application in a healthcare setting.
|Situation||This is the initial step of SBAR and functions as an introduction to the circumstances currently taking place.
The background or context of the situation should be summarized concisely and given to first responders or other members of the patient’s healthcare team in order for them to fulfill their role accordingly.
The individual tasked with disclosing this information should be able to identify the problem that needs to be addressed and formulate a way to succinctly relay their assessment of the problem.
This aspect of SBAR is typically recommended to be disclosed in under 10 seconds.
|Comprehensively assessing a situation and concisely delivering that information may seem intimidating but repeated practice will make it nothing more than second nature.
This formula is followed by many:
2. Provide quick information about the patient. This includes reason for admission, age, sex, name, and their current status or current symptoms.
Some questions to aid the formulation of this aspect include:
1. What is going on with the patient?
2. What is the situation you are calling about?
|Background||This aspect is supplementary to the first as it extends on the situation by contextualizing it. It is typically supplied by informants of the healthcare nature as it serves more of a diagnostic role.
Background is given by providing the circumstances or conditions surrounding the patient’s situation. This includes giving context to the patient’s condition or explanations behind their admission to the hospital.
At this stage of SBAR, a medical chart is typically expected to be involved so the patient’s data can be taken down for later assessments, if necessary.
|This is the point where medical-based information plays an important role. Information that that generally comes out at this point includes:
· Date and reason for admission
· Admitting diagnosis
· Recent vital signs
· Laboratory status
· Code status
· Medication that the patient is currently taking
Questions to ask at this stage include:
1. What is the key clinical background of the patient?
2. What is the context of the situation?
|Assessment||This is considered the problem-diagnosis stage of SBAR as it calls for an evaluation of the problem and the root cause behind it. It typically plays out as a conversation between healthcare professionals concerning the appropriate response towards the situation.
It is especially important that irrelevant information be excluded in this aspect as it can harm the decision-making of the healthcare practitioners.
The assessment given should include an analysis of the patient’s situation based on their condition, test results, responsiveness to treatment if any, and the like.
|An assessment should include the following:
· Condition and the severity of the condition
· New developments concerning the condition
Questions to ask at this stage include:
· What do I think the problem is?
· What is the assessment of other healthcare professionals assigned to the patient?
|Recommendation||At this stage, healthcare professionals are tasked with discerning the solution-end of the assessment. They should consider the options available and decide which routes are the best course of action for the patient.
The recommendations given should take into account the previous aspects of SBAR, namely situation, background, and assessment. When stating recommendations, the healthcare professional should be very clear and specific with their suggestions as to lessen miscommunication.
A nurse or non-healthcare professional may feel intimidated when giving their recommendations to a superior. However, these recommendations should still be made as they will be subject to discernment and may aid in painting a complete view of the situation.
| A recommendation can range from very specific courses of treatment to general suggestions. Some examples include:
· Recommendation for a doctor to do a check up on a patient
· Recommendation for a patient to get a second opinion from another healthcare professional
· Recommendation for treatment of the patient (e.g. surgery, physical therapy, blood work, etc.)
· Recommendation for the patient to get follow-up tests done
Questions to ask at this stage include:
· What action do I think is in your best interest?
· What action do your nurses think is in your best interest?
When should SBAR be used?
SBAR should generally be used to inform and guide any communication with other healthcare professionals regarding patient information. Some specific situations in which SBAR can be optimized include:
- When the medical team is resolving a patient issue.
- For conversations including doctors, nurses, physical therapists, and other healthcare professionals.
- During emergency or crisis situations wherein a rapid response team ought to have access to information on the situation.
- For both in-person and on-call discussions regarding a patient’s care.
- When escalating or raising a concern related to a patient’s care.
- When handing off communication to other healthcare professionals in between shifts or during a shift-change.
- During safety and emergency briefings.
However, a necessary caveat to take note of is that SBAR cannot be blanketly applied across the broad. As with any method, there are limitations to its use. These include:
- When the user is unfamiliar with SBAR and may misuse the method.
- When it comes into conflict with HIPAA in terms of disclosing patient information.
- When healthcare professionals are unable to give a recommendation due to pressure.
Who should be using SBAR?
The Agency for Healthcare Research and Quality recommends that SBAR be used by:
- Administrators communicating with physicians
- Nurses communicating with other nurses
- Nurses communicating with technicians
- Nurses communicating with physicians
- Nursing assistants communicating with nurses
- Physicians communicating with other physicians
- Pharmacy communicating with nurses or physicians
- Residents communicating with attending physicians
While the AHRQ lists out a specific set of actors for the utilization of SBAR it should be noted that the communication technique will generally aid any healthcare practitioner. It is a valuable tool in executing clear and efficient communication.
Why should SBAR be used?
The Joint Commission endorses SBAR as a best practice for healthcare practitioners. They have called it “a powerful tool that is used to improve the effectiveness of communication between individuals.” This is because SBAR provides the benefit of conveying a complete message in a brief manner.
The advantage of being able to paint a complete picture with this communication method is accuracy. Doctors, nurses, and other healthcare professionals are better able to communicate accurate information and recommendations concerning a patient’s situation through SBAR.
With SBAR being the standard in healthcare there is now a streamlined means of communication. This means that there becomes less room for human error as communication becomes more systematic.
SBAR in Nursing
The issue of critical information being left out of communications between healthcare professionals has been a long-standing problem of patient safety. SBAR has worked to drastically improve the methods of communication in a hospital setting. It has proven especially effective when adopted by nurses, resulting in enhanced patient outcomes.
A comparative study published in the National Library of Medicine concluded that the use of SBAR by nurses resulted in a lower incidence rate of serious adverse events in hospital wards. Introducing SBAR as a common practice for nurses was found to increase the perception of effective communication as well as collaboration. There was also a decrease in unexpected deaths.
While another study published in the Asia-Pacific Journal of Oncology Nursing found that applying the SBAR technique was particularly effective in easing communication among nurses during shift-changes. The nurses found SBAR to “help organize their thinking and streamline data.” This made the transition of care smoother and ultimately resulted in better patient care.