SBAR Nursing: A How-To Guide

Failure to rescue (FTR) is often used as an indicator of a hospital’s quality of care, according to the American Hospital Association. FTR includes failure to recognize patient deterioration, failure to communicate concerns, and failure to diagnose and treat the patient appropriately, among other factors. Effective communication can prevent FTR in many cases.

Good nurse-physician communication is critical to hospital effectiveness; it reduces the likelihood of error, reduces unnecessary stress on the patient and reduces workplace stress and contention between nurses and physicians, according to a study by Dr. Susan Renz et al published in Geriatric Nursing. “Standardizing the structure of critical communications helps the speaker organize thoughts and be prepared with critical information, and helps the receiver to be focused on the important points of the message by eliminating the less important aspects,” the study states.

In the busy and high-stress world of healthcare, however, good communication skills can fall by the wayside. One of the most effective tools for facilitating communication is SBAR, considered a best practice by the Joint Commission.

What Is SBAR?

SBAR stands for Situation, Background, Assessment and Recommendation. According to Safer Healthcare, SBAR was originally developed by the U.S. Navy as a way to communicate information on nuclear submarines. However, the healthcare system adopted it in the 1990s, and now it’s used worldwide.

The Institute for Healthcare Improvement says, “SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action.” It gives clinicians a specific, unambiguous way to communicate critical information to one another, leaving little room for error and minimizing the chance that a miscommunication will cause patient deterioration.

Dr. Renz’s study concluded that 87.5 percent of nurses working in a nursing home setting found SBAR to be a useful tool for organizing and communicating information. Though some nurses cited time constraints and existing communication barriers as obstacles to SBAR, “physicians reported that the quality of communication with nurses about change in resident condition had improved since project implementation.”

SBAR Nursing

The components of SBAR are as follows, according to the Joint Commission:

• Situation: Clearly and briefly describe the current situation.
• Background: Provide clear, relevant background information on the patient.
• Assessment: State your professional conclusion, based on the situation and background.
• Recommendation: Tell the person with whom you’re communicating what you need from him or her, in a clear and relevant way.

Safer Healthcare provides the following example of SBAR being used in a phone call between a nurse and a physician:

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

Situation

“Here’s the situation: Mrs. Smith is having increasing dyspnea and is complaining of chest pain.”

Background

“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.”

Assessment

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

Recommendation

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

Safer Healthcare goes on to describe the process for enacting an SBAR briefing:

• Organize information first, so it’s clear before communication begins. Only communicate relevant information.
• When presenting a briefing, be clear and concise, and use each element of SBAR to communicate the relevant information.
• Work with the other person to arrive at the required action. If he or she needs to clarify information or ask follow-up questions, assist with this.

Safer Healthcare also offers sample video vignettes demonstrating effective use of SBAR for nurse-physician communications.

Learning Effective Nursing Communication Skills

Education is one of the best ways to learn communication skills. An RN to BSN online from Rivier University prepares nurses not only for the clinical demands of the job, but also focuses on the communication skills that are so important for improving patient outcomes and recognizing a decline in a patient’s condition. Students learn in a convenient and flexible online environment that accommodates their work and personal schedules.