Skill List > SBAR – Situation, Background, Assessment and Recommendation Handover Tool
Clinical Alert
Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Written by: Kate Olson MA RN PGDip Ed FHEA
Last updated:  October 2020
Learning Objective
The purpose of this learning material is to provide you with a resource to: • Facilitate the development of new knowledge • Build on existing knowledge • Test knowledge • Assess the skill in practice

INTRODUCTION

SBAR stands for Situation, Background, Assessment and Recommendation. It is a tool that was originally developed for use in nuclear submarines in the United States navy (Wyatt 2018). It was first used in healthcare in Kaiser Permanente hospital in the US in 2003 as a means to improve nurse–physician communication in acute situations (Shahid & Thomas 2018). It has now been adopted across the world and is used in a variety of healthcare settings (NHS Improvement 2018, Spranzi & Norton 2020). Other mnemonics may be used as a handover tool, such as RSVP (Reason-story-vital signs-plan) (Featherstone et al 2008); however, SBAR is more widely used. 

In different clinical settings and countries, SBAR has been adapted to:

  • SBARD (situation, background, assessment, recommendation, decision)
  • ISBAR (introduction or identify, situation, background, assessment, recommendation)
  • SBAR-R (situation, background, assessment, recommendation, read-back) 
  • ISOBAR (identify, situation, observation, background, agreed plan, read back) 
  • K-ISBAR (kindness, introduction, situation, background, recommendation)

(Brewster & Waxman 2018; Muller et al 2018; Roach 2017; Vlitos & Kamara 2016). 

Poor communication is a contributing factor in adverse events (De Meester et al. 2013). SBAR was introduced to improve communication and reduce adverse events through being a formal, structured process (National Institute for Health and Care Excellence (NICE) 2007).  The information given in the handover should be concise and focused (Royal College of Physicians (RCP) 2018). The use of standardised prompt questions enables staff to communicate effectively and reduces the need for repetition (NHS Improvement 2018).

SBAR can be used in any clinical setting; in-person or over the phone, and between different disciplines.

Since the inception of SBAR into healthcare, a number of studies have demonstrated the benefits of using the tool. This has been in relation to improved communication between healthcare professionals; reduction in adverse events; improved teamwork; reduction in unexpected deaths; improved interprofessional collaboration; increased critical thinking and it helps users in anticipating the information needed by colleagues (Coley 2015; De Meester et al 2013; Ferrara et al 2017; Muller et al 2018; RCP 2018; Shahid & Thomas 2018; Titu 2019). Table 1 gives an example of an SBAR handover. 

Table 1 Example of an SBAR handover

Situation
  • Hello, this is Staff Nurse Williams calling from Ward 3
  • I am calling about Elsie Roberts
  • Her condition has deteriorated in the last 10 minutes and she appears to be in hypovolaemic shock
  • She has a NEWS score of 13. It was previously 0
 Background  
  • Mrs Roberts was admitted 2 hours ago with a suspected gastrointestinal bleed
  • She is a 68-year-old lady and has been passing black stools and had an episode of haematemesis (vomiting blood) this morning
  • She regularly takes NSAIDs for arthritis in her left knee but has no other past medical history of note
  • She has an infusion of 1 litre of normal saline running over 8 hours
  • She is currently nil by mouth
 Assessment  
  • Her pulse rate has increased to 118 beats per minute; her respiratory rate has increased to 25 breaths per minute; her blood pressure has dropped to 80/50 mmHg; her peripheral oxygen saturation has dropped to 92% on room air; she is only responding to voice (previously alert)
  • She has had a FBC, U & Es and cross-match performed and we are awaiting results
  • Her abdomen appears swollen and tender
  • She has had a further episode of vomiting blood
  • We have commenced her on oxygen therapy as per her prescription chart
 Recommendations
   
  • I would like you to review her as soon as possible, please
  • Is there anything you would like us to do in the meantime?

PROCEDURE 

  1. Perform hand hygiene and put on a disposable apron before patient contact. Wear personal protective equipment where necessary.
  2. Check the patient’s identity – using the patient’s nameband and/or verbally, according to local policy. 
    Rationale – To ensure you have the correct patient.
  3. After performing a clinical assessment such as ABCDE (airway, breathing, circulation, disability, exposure), gather together the pertinent information required for the handover. A written summary of the SBAR is useful. 
    Rationale – This will ensure that the handover can be concise and smooth and that important information is not left out.  
  4. Identify the appropriate individual or team for the handover to be given to (this may be in person or over the phone).
    Rationale – This may vary depending on the clinical situation and the local policy. For example, it might be the patient’s doctor or critical care outreach team who would be the first point of contact.
  5. Communicate the Situation: this is a concise statement of the problem and should include: your identity; the location you are calling from; the patient that you are calling about; and the immediate reason for your call.
    Rationale – This will enable the individual who is taking the handover to understand the urgency of the situation.
  6. Communicate the Background: this is focused and brief information related to the situation and should include: relevant details about the patient including reason for admission, past medical history, length of stay, recent operations/investigations/procedures, current medications/treatments (if relevant) and anything else pertinent to the reason for calling. 
    Rationale – This will give the context to the situation, particularly if the receiver of the handover does not know the patient. It will help in the decision-making process to understand what treatment may have already been tried or what may have led to the current situation.
  7. Communicate the Assessment: what are the most recent findings such as vital signs, NEWS score, findings of investigations such as ECG, chest X-ray, blood tests. How does the patient appear? What is their conscious level?  What is the response to recent treatment? Any evidence of bleeding? This may have been based on an ABCDE (Airway, Breathing, Circulation, Disability, Exposure) assessment. 
    Rationale – An up-to-date accurate assessment will help to identify the urgency of the situation and what may be the current problem (if not already known). It will also help the decision-making process with regards to appropriate treatment and management. 
  8. Communicate your Recommendations: clarify expectations ensuring you explain what you need, being specific about the request and timeframe. Identify if there is any treatment or actions that need to be carried out while waiting for the patient to be reviewed. 
    Rationale – It is important that the receiver understands what is expected of them.
  9. Carry out any treatment/investigations as requested and monitor the effects of these. 
    Rationale – Immediate treatment such as prescribed intravenous fluids may need to be commenced prior to the patient being reviewed. The response to this treatment should be monitored.

ONGOING CARE, MONITORING AND SUPPORT 

  • Reassess the patient as required.

DOCUMENTATION

  • Document results of the handover. 
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