There are many templates available to guide you through the use of SBAR, but committing the easy-to-remember organizational framework to memory will help you standardize its use for communicating about your patients.
SBAR helps you prioritize and organize what is most critical about each individual patient’s situation, regardless of whether you are explaining it in person, on the phone, or in writing. Its use ensures that the most vital information is relayed quickly so that appropriate action can be taken.
The most important things for you to remember when using SBAR are:
- Keep all points relevant
- Keep all points concise
- Eliminate unnecessary information
The information conveyed via SBAR is meant to be comprehensive, but not overly detailed. It may invite additional questions that you should be prepared to answer, but even without those questions being asked should serve to provide enough information for another healthcare professional to move forward.
It’s also important to note that the recommendations may include medical interventions (such as medication recommendations, radiology, or lab draws), but ultimately, it is up to the medical provider to place orders for the patient and determine the next steps.
Nurses are often asked for their professional recommendations because they spend the most time with the patient and might be picking up on subtle cues from the patient.
SBAR Examples
Example #1:
Emergency nurse using SBAR framework regarding a pediatric patient admitted with vomiting and abdominal pain
Here is how the nurse would quickly provide information to the pediatrician:
S (Situation): Dr. Smith, this is Lynne in the Emergency Department Five-year-old Julia Baker was brought to the E.R. by her father two hours ago complaining of abdominal pain and experiencing nausea, vomiting, and diarrhea. I would like to update you on her condition and clarify orders.
B (Background): Julia’s father reports that complaints of abdominal pain started this morning and she refused food. Since being admitted her pain has gotten worse (now rated as an 8 out of 10) and is now radiating to the right lower quadrant. Oral fluids were ordered and her fever is 103.2 F orally.
A (Assessment): Julia looks pale, is febrile, and is experiencing increased pain, vomiting, and diarrhea since her time of admission.
R (Recommendation): I believe that Julia should be given intravenous fluids and that an ultrasound should be considered in order to determine whether she has appendicitis.
Example #2:
Evening nurse using SBAR report to convey information to morning shift nurse regarding patient admitted from nursing home
S (Situation): Mr. Goldring is an 83-year-old male in room 212, admitted last night at 23:20. Arrived via ambulance from Woods Manor North Nursing Home where he reportedly fell out of bed.
B (Background): Mr. Goldring is diabetic and has mild dementia. All of his supporting documentation has been entered into his chart, including a DNR. Family was notified of the fall by the nursing home and I contacted his daughter with an update shortly after she was admitted. Expect family to arrive this morning to meet with physician.
A (Assessment): Diagnostic X-rays reveal hip fracture, physical examination shows bruising on thigh, skin intact. Patient reports mild pain, morphine administered at 01:00 by ER staff.
R (Recommendation): Physician consultation with surgeon scheduled for this morning. Continue monitoring for pain, follow-up with surgeon regarding next steps.
History of SBAR
Though SBAR is a healthcare communication tool, its roots lie in the U.S. military.
Before Doug Bonacum joined Kaiser Permanente’s environmental health and safety department, he was a part of the U.S. Navy’s submarine force. While on active duty he used a communication technique he referred to as SBAR to succinctly describe and assess mission-critical information up and down throughout the hierarchy.
Years later when he joined Kaiser, he encountered,
- Physicians and nurses complaining about poor communications
- Physicians complaining about nurses rambling
- Nurses complaining that physicians were not following their recommendations
He recognized that the structured format that had proven successful for the military would also help both the receivers and transmitters of patient information, as well as the patient.
Now Vice President of Safety Management at Kaiser Permanente, he points to the need for the healthcare hierarchy to be “flattened” in the interest of patient safety, and credits SBAR for accomplishing that goal.