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Situation, Background, Assessment, Recommendation (SBAR)

SBAR is a structured method for communicating critical information that requires immediate attention and action contributing to effective escalation and increased patient safety.

SBAR can also be used effectively to enhance handovers between shifts or between staff in the same or different clinical areas.

Why use SBAR?
How can SBAR help me?
When does SBAR work best? 
The trouble with handovers

Recommended uses and settings for SBAR

  • Urgent or non urgent communications
  • Escalation and handover
  • Verbal or written exchanges
  • Ideal for emails
  • Clinical or managerial environments

For a structured approach to introducing SBAR in the operating theatre, see The Productive Operating Theatre module on Team-working.

SBAR film scenarios
The following series of films show how particular scenarios might play out without the use of SBAR.  The same scenario is then repeated showing how more effective communication can be achieved in the same situation using SBAR.

SBAR scenarios last between 3 and 5 minutes and cover the following:

SBAR film scenarios 

See the escalation film scenarios
See the handover film scenarios

Additional SBAR resources

Click through to the following additional downloadable resources:

SBAR overview

Why use SBAR?
Inadequate communication is recognised as a being the most common root cause of serious errors – both clinically and organisationally.  There are some fundamental barriers to communication across different disciplines and levels of staff.  These include hierarchy, gender, ethnic background and differences in communication styles between disciplines and individuals.  Communication is more effective in teams where there are standard structures of communication in place.

  • SBAR reduces the incidence of missed communications that occur through the use of assumptions, hints, vagueness or reticence they may be caused by the authority gradient.
  • It helps to prevent breakdowns in verbal and written communication, by creating a shared mental model around all patient handovers and situations requiring escalation, or critical exchange of information.
  • SBAR is an effective mechanism to level the traditional hierarchy between doctors and other care givers by building a common language platform for communicating critical events, thereby reducing barriers to communication between healthcare professionals.
  • As a memory prompt, it is easy to remember and encourages prior preparation for communication.
  • Used during handover SBAR can reduce the time spent on this activity thereby releasing time for clinical care

How can SBAR help me?

SBAR is an easy to remember mechanism that you can use to frame conversations, especially critical ones, requiring a clinician's immediate attention and action. It enables you to clarify what information should be communicated between members of the team, and how. It can also help you to develop teamwork and foster a culture of patient safety.

The tool consists of standardised prompt questions within four sections, to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition.

Using SBAR prompts staff to formulate information with the right level of detail. The tool helps staff anticipate the information needed by colleagues and encourages assessment skills.

When does SBAR work best?

The tool can be used to shape communication at any stage of the patient's journey, from the content of a GP's referral letter, consultant to consultant referrals through to communicating discharge back to a GP.

When staff use the tool in a clinical setting, they make a recommendation which ensures that the reason for the communication is clear. This is particularly important in situations where staff may be uncomfortable about making a recommendation i.e. those who are inexperienced or who need to communicate up the hierarchy. The use of SBAR prevents the hit and miss process of ‘hinting and hoping'.

Including SBAR in a Curriculum
Providing flexible learning opportunities that can be accessed by a variety of learners, from pre-registration students to senior professional colleagues, can be highly effective in developing confidence and competence for effective and structured communication.

The training guide includes a suggested lesson plan and activities that can be used to introduce SBAR to a group of learners. 

Download the SBAR Implementation and Training Guide

Human Factors
Communication is essential to good team work, and team work is essential to patient safety. Effective communication is one of a number of Human Factors that determine how we interact with our colleagues and our surroundings.

 The Trouble with Handovers

 

The film The Trouble with Handovers has been produced by the South Central Patient Safety Federation's Human Factors work stream 'No needless ignorance'.  Most patients experience multiple handovers between admission and discharge from our care.  This film, introduced and narrated by Phil Hammond, follows a patient from their home to hospital.  It highlights the importance of good handover and illustrates the consequences when information loss occurs over a series of handovers.  It is a great way of raising situational awareness amongst staff of the importance of their contribution at each handover.