Situation, Background, Assessment, Recommendation (SBAR)
Situation, Background, Assessment, Recommendation (SBAR) is a structured communication framework used primarily in healthcare settings to enhance the clarity and efficiency of information exchange among medical staff. Originating from practices employed by US Navy personnel, SBAR was adapted for clinical use to address the frequent miscommunication that can lead to medical errors, identified as a leading cause of patient fatalities in the United States. The technique consists of four key components: the 'Situation' provides an overview of the current patient status, 'Background' delivers relevant medical history, 'Assessment' identifies any issues or concerns, and 'Recommendation' suggests potential courses of action.
Introduced by Michael Leonard and colleagues for Kaiser Permanente in 2002, SBAR was designed to bridge the communication gap between nursing and medical practices, promoting a more cohesive approach to patient care. Its implementation has been endorsed by major healthcare organizations, such as the Joint Commission and the World Health Organization, reflecting a commitment to improving patient safety. SBAR is not limited to doctor-nurse interactions; it has been successfully adapted for various healthcare communications, including interprofessional dialogues and electronic exchanges. By standardizing how patient information is conveyed, SBAR aims to reduce the risk of miscommunication, thus fostering better healthcare outcomes.
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Situation, Background, Assessment, Recommendation (SBAR)
Situation, Background, Assessment, Recommendation (SBAR) is a standardized method of communicating that offers physicians and medical staff a way to share patient information accurately and efficiently. Created by Michael Leonard, Director of Patient Safety for the Colorado Permanente Medical Group and for Kaiser Permanente, in Oakland, California, and his colleagues Doug Bonachum and Suzanne Graham, SBAR is designed to bridge the gap between the narrative, descriptive communication style that nurses are trained to use and the succinct, focused style that is part of physicians’ training. Based upon procedures used by US Navy personnel on nuclear submarines, SBAR provides a model of structured communication for hospitals and other healthcare facilities to use in handoffs, patient transfers, and other, often critical, conversations.
Overview
According to the US National Library of Medicine's StatPearls in 2024, medical errors have been reported as the third-leading cause of death in the United States. According to the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations), errors attributable to miscommunication are the leading cause for medication errors, delays in treatment, and wrong-site surgeries, as well as the second most frequently cited root cause for operative and postoperative events and fatal falls. In 2006, the Joint Commission made standardized handoff communications a National Patient Safety Goal (NPSG). Although the Joint Commission did not require standardized documentation forms, the standardization did require health care organizations to define, inform staff, and put into practice a standardized process in which information about patient care is communicated.
The SBAR technique gives medical staff a tool to achieve this standardized process. It requires that the communication include the patient’s current status (Situation), the clinical contexts that include any medical history of the patient that is pertinent to current care and patient condition (Background), identification of the problem (Assessment), and a suggested course of action (Recommendation). It establishes expectations about exactly what will be communicated between medical team members. Although Leonard and his colleagues designed the SBAR technique for communication between doctors and nurses in critical, high-risk situations, health care professionals have adapted the strategy for other uses, including nurse-to-nurse communication, nurse-to-transporter communication, doctor-to-doctor communication, and communication among interprofessional team members in a rehabilitation setting. In addition to face-to-face communications, it is used in telephone conversations and in electronic communications such as email and voice mail.
Implementation of the SBAR technique requires both staff training and overcoming some ingrained beliefs. For example, nurses have been taught that medical diagnosis is outside the realm of their job description, and the SBAR model specifically requires that the nurse include in their communication to the physician recommendations concerning patient care. Of course, the decision about what action to take ultimately rests with the physician.
A hospital patient typically encounters three shifts of nurses each day and may be treated by multiple healthcare practitioners during that same time period. The opportunities for miscommunication are enormous, and the consequences can include inappropriate treatment, lapses in continuity of care, and harm to the patient that in some incidents results in fatality. The SBAR technique significantly decreases the chance of such miscommunication. The SBAR technique is approved by the Joint Commission, the Institute for Healthcare Improvement, and the World Health Organization for standardizing communication and improving patient care.
Bibliography
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