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The Situation, Background, Assessment and Recommendation (SBAR) technique has become the Joint Commission's stated industry best practice for standardized communication in healthcare; effortlessly structuring critical information primarily for spoken delivery. Regular use of SBAR is an important part of any organization's Crew Resource Management (CRM) family of skills; helping caregivers function as effective team members while establishing a culture of quality, patient safety and high reliability.

SBAR promotes quality and patient safety, primarily because it helps individuals communicate with each other with a shared set of expectations. Staff and physicians use SBAR to share patient information in a clear, complete, concise and structured format; improving communication efficiency and accuracy.

Originally developed by the United States Navy as a communication technique that could be used on nuclear submarines, Safer Healthcare helped introduce SBAR into healthcare in the late 1990's as part of its Crew Resource Management (CRM) training curriculum. Since that time, SBAR has been adopted by hospitals and care facilities around the world as a simple yet effective way to standardize communication between care givers.

The SBAR technique offers hospitals and care facilities a solution to bridge the gap in communication, including hand-offs, patient transfers, critical conversations and telephone calls. It creates a shared expectation between the sender and receiver of the information being shared.

  • First, quickly organize the briefing information in your mind or on paper using the four elements (Situation, Background, Assessment and Recommendation) in sequence. Only the most relevant data is included, and everything irrelevant or of secondary importance is excluded.
  • Second, present your briefing. Since team members can immediately recognize and understand the familiar, predictable SBAR format, you help them more efficiently and effectively address a situation or solve a problem.
  • Third, they may confirm, clarify or enhance what you’ve said. then work with you to take the required action.

The following are links to sample video vignettes from Safer Healthcare's award-winning SBAR Training Video for Acute Care Settings (DVD) to better understand the concepts. Safer Healthcare also offers an SBAR Long-Term Care specific version for Long-Term and Convalescent Care facilities and personnel.

SBAR increases overall operational excellence, creates an environment in which a team can work together more effectively and, most important, improves the safety of the patients they serve. One of the ways SBAR does this is by creating a shared mental model that ensures members are on the same page. SBAR also requires you to speak frankly and openly with others, regardless of their position in the organization.

SBAR promotes better communication in Healthcare. In most cases nurses and physicians communicate in very different ways. Nurses are taught to report in narrative form, providing all details known about the patient. Physicians are taught to communicate using brief “bullet points” that provide only the key information to the listener.

The following is an example of a nurse call to a physician using SBAR:

"Dr. Jones, this is Deb McDonald RN, I am calling from ABC Hospital about your patient Jane Smith."

"Here's the situation: Mrs. Smith is having increasing dyspnea and is complaining of chest pain."

"The supporting background information is that she had a total knee replacement two days ago. About two hours ago she began complaining of chest pain. Her pulse is 120 and her blood pressure is 128 over 54. She is restless and short of breath."

"My assessment of the situation is that she may be having a cardiac event or a pulmonary embolism."

"I recommend that you see her immediately and that we start her on O2 stat. Do you agree?"

The SBAR technique creates the shared mental communication model that ensures the nurse and physician remain on the same page throughout the conversation.

The Joint Commission provides their thoughts on the critical role SBAR plays in the transitions of care. The following excerpt is taken from their recent Hot Topics in Healthcare: Transitions of Care paper.

Transitions of care refer to the movement of patients between health care practitioners, settings, and home as their condition and care needs change. For example, a patient might receive care from a primary care physician or specialist in an outpatient setting, then transition to a hospital physician and nursing team during an inpatient admission before moving on to yet another care team at a skilled nursing facility. Finally, the patient might return home, where he or she may receive care from a visiting nurse or support from a family member or friend. The scope of the Joint Commission transitions of care initiative encompasses transitions of patients between health care settings. For example, from a nursing home to a home care agency.

Unfortunately, these transitions do not always go smoothly. Ineffective care transition processes lead to adverse events, and higher hospital readmission rates and costs. One study estimated that 80% of serious medical errors involve miscommunication during the hand-off between medical providers. Problematic transitions occur from and to virtually every type of health care setting, but especially when patients leave the hospital to receive care in another setting or at home, according to experts on this issue. To reduce both readmission rates and adverse events, hospitals must improve the effectiveness of transitions of care in which they play a role. The federal government has taken notice: Hospitals with unacceptably high readmission rates for Medicare and Medicaid patients will soon face financial penalties under the Patient Protection and Affordable Care Act.

Many factors contribute to ineffective transitions of patient care, and these root causes often differ from one health care organization to another. The root causes most often described in medical literature and by experts include:

Communication breakdowns. Care providers do not effectively or completely communicate important information among themselves, to the patient, or to those taking care of the patient at home in a timely fashion. The communication method - whether verbal, recorded, or written - is ineffective. For example, the Center for Transforming Healthcare’s hand-off communication project found these risk factors among those relating to communication:

  • Expectations differ between senders and receivers of patients in transition.
  • Culture does not promote successful hand-off (e.g. lack of teamwork and respect.
  • Inadequate amount of time provided for successful hand-off.
  • Lack of standardized procedures in conducting successful hand-off, ex: use of SBAR (Situation, Background, Assessment and Recommendation) techniques.

The Joint Commission on Accreditation of Hospitals has added standardized communication to the Patient Safety Goals and formally recommends SBAR as the industry best practice.

Safer Healthcare's SBAR products are designed to give your staff members the following educational advantage:

  • An understanding of the SBAR technique and why it is useful.
  • The ability to increase communication productivity.
  • Standardization of communication messages.
  • Practical tools to begin using SBAR immediately.
  • Support materials to sustain program momentum and progress.

Avoid communication breakdowns. Meet Joint Commission goals with standardized transitions of care and hand-off communications. Increase the effectiveness of nurse to physician communication. Equip your team to communicate effectively with practical tools.

Safer Healthcare offers customized SBAR training workshops and customized SBAR resources including checklists, hand-off guides and other educational products. Contact Safer Healthcare's team of experts for more information.

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