ISBAR (Identify, Situation, Background, Assessment and Recommendation)
ISBAR stands for Identify, Situation, Background, Assessment, and Recommendation, and is a structured communication framework primarily used in healthcare settings to ensure effective patient handovers. This tool is designed to facilitate the transfer of care between medical practitioners, enhancing the quality of communication and ultimately improving patient safety and outcomes. The first step, "Identify," involves introducing the individuals in the conversation, followed by "Situation," which describes the current issue or concern regarding the patient. "Background" provides the patient's medical history, while "Assessment" includes the healthcare professional's observations and clinical judgments. Finally, "Recommendation" outlines the proposed next steps in the patient's care.
ISBAR originated from the SBAR technique, developed by the US Navy for communication in high-risk environments, and has since been adapted by the healthcare sector to address critical information transfer challenges. Effective use of ISBAR not only fosters clear communication among healthcare providers but also enhances relationships with patients and their families. By implementing this structured approach, medical personnel can minimize the risk of errors, ensure timely care, and promote a culture of safety within healthcare environments.
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Subject Terms
ISBAR (Identify, Situation, Background, Assessment and Recommendation)
In the medical field, ISBAR is an acronym for identify, situation, background, assessment, and recommendation that refers to the steps that should be taken when a patient is handed over from one medical practitioner to another, such as during a shift change. During patient handover, also called transfer of care, a patient's care is reassigned either temporarily or permanently to another healthcare professional, department, or facility. The purpose of ISBAR is to set up communication standards for medical personnel to ensure that patients receive continued quality care. The first step, identify, has not always been a part of ISBAR—or SBAR as it was known—and was added to introduce all individuals involved in the communication. ISBAR also is used outside of medical settings, such as in the information technology (IT) field. The US Navy developed SBAR as a way to communicate while on submarines, but the healthcare sector adopted it as a tool to standardize communication.
Background
Clear communication is key because it can mean the difference between life and death in certain situations—especially in the healthcare environment concerning patients. A misunderstanding can have dire consequences and can compromise the safety of patients. Numerous healthcare providers communicate with one another on a daily basis through verbal, nonverbal, and written (or electronic) methods. They also interact with patients, their family members, and caregivers to deliver care and relay information. Effective communication skills are imperative to building and maintaining trusting relationships with patients and fellow healthcare providers.
Communication is especially important during transfer of care to prevent negative health effects and consequences to a patient. Poor communication can result in errors and interruptions in treatment or medications, delays in diagnosis, and missed or double tests. Any of these can have dire results, leading to serious injury, illness, or even death, which can result in malpractice lawsuits and other legal troubles for medical personnel and facilities.
Information on all aspects of care during a patient transfer should be accurate, clear, relevant, and timely. To prevent mistakes that could be detrimental to a person's health, the tool ISBAR has been developed. ISBAR is a standardized and structured communication tool that improves communication not only among health practitioners but also between medical providers and patients themselves. By using ISBAR, medical personnel can build relationships, facilitate continuity of care, promote safety, improve outcomes, and increase patient satisfaction.
While the US Navy developed the method, the Joint Commission in the early twenty-first century created a set of National Patient Safety Goals to improve communication among health practitioners. It developed these goals to improve communication, since disorganized and unclear communication was identified as the main cause of unexpected death in medical settings.
While nurses and physicians typically use ISBAR when communicating with one another, the process can also be used to communicate with other medical staff. When a nurse needs to schedule several tests for a hospitalized individual, they must communicate with several people. For example, the nurse must notify the department heads of the times of each test and the dietary staff to hold meals until after the tests are completed. If the nurse does not tell the dietary staff that the patient needs to fast until after the tests, then the patient might be given a meal before the test and then delay pertinent assessments. This is why communication needs to be thorough and clear.
Overview
In ISBAR, identify refers to the people involved in the communication; situation is the issue being conveyed; background is the history of the patient; assessment refers to the observation of symptoms; and recommendation is the care suggestion.
Before a nurse begins the ISBAR process, they should assess the patient and read their chart and any lab or test results. The nurse should also review any physician or nurse progress notes to ensure that they know the background of the patient before contacting the physician.
In identify, a nurse identifies themself, the physician, and the patient. For example, "Hello, Dr. Kim, I am nurse Emanuel and calling about your patient, Mr. Williamson, who is under the care of our hospital in Room 17A."
In situation, the nurse explains what is going on, and expresses observations and concerns. "Mr. Williamson is complaining of severe pain in his lower left abdomen and says he has blood in his urine. He has been sent for blood and urine analyses, and we are awaiting the results. His blood pressure is 110/70 mm HG, pulse rate is 112, and temperature is 102.3 degrees F. He describes the pain as 9 out of 10 on the pain scale."
In background, the nurse provides a brief history on the patient. "Mr. Williamson is a 42-year-old male who was admitted for severe abdominal pain six hours ago. He has previously been treated in the last three months for nephrolithiasis, or kidney stones. His clinical presentation on admission included an elevated heart rate and body temperature."
In assessment, the nurse tells the physician what they believe is wrong. "I think Mr. Williamson has kidney stones."
In recommendation, the nurse suggests a treatment plan. "Dr. Kim, will you be coming to see Mr. Williamson? Would you like me to contact radiology for an X-ray or ultrasound of the patient's abdomen, or should we wait on the lab results? Should I give the patient pain medication and start an IV?"
By using the ISBAR tool, medical personnel can effectively communicate with other people in the profession. Clear and concise communication in a healthcare setting is important to patient treatment and safety.
Bibliography
Burgess, Annette, et al. “Teaching Clinical Handover with ISBAR.” BMC Medical Education, vol. 20, no. 2, 2020, p. 459, doi.org/10.1186/s12909-020-02285-0. Accessed 2 Nov. 2024.
Cudjoe, Kim Giselle. "Add Identity to SBAR." Nursing Made Incredibly Easy!, vol. 14, no. 1, Jan./Feb. 2016, pp. 6–7, journals.lww.com/nursingmadeincrediblyeasy/Fulltext/2016/01000/Add‗identity‗to‗SBAR.2.aspx. Accessed 22 May 2017.
Gadea-Company, Patricia, et al. “Impact of the Implementation of Identification-Situation-Background-Assessment-Recommendation (ISBAR) Tool to Improve Quality and Safety Measure in a Lithotripsy and Endourological Unit.” PloS One, vol. 18, no. 6, 2023, p. e0286565, doi.org/10.1371/journal.pone.0286565. Accessed 2 Nov. 2024.
"ISBAR: Adding an Extra Step in Handoff Communication." Strategies for Nurse Managers.com, www.strategiesfornursemanagers.com/ce‗detail/222773.cfm. Accessed 22 May 2017.
O'Shaughnessy, Gweneth. "SBAR (Situation – Background – Assessment – Recommendation)." Gift of Life Institute, 14 Aug. 2023, www.giftoflifeinstitute.org/sbar-situation-background-assessment-recommendation. Accessed 2 Nov. 2024.
"SBAR Tool: Situation-Background-Assessment-Recommendation." Institute for Healthcare Improvement, www.ihi.org/resources/tools/sbar-tool-situation-background-assessment-recommendation. Accessed 2 Nov. 2024.
"Tool: SBAR." Agency for Healthcare Research and Quality, Nov. 2019, www.ahrq.gov/teamstepps-program/curriculum/communication/tools/sbar.html. Accessed 2 Nov. 2024.