In the SBAR model, what should be conveyed when explaining the situation? (Select all that apply)

Edwards C, Woodard EK. SBAR for maternal transports: going the extra mile. Nursing for women’s health. 2008;12(6):515–20.
Article PubMed Google Scholar
Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor to medical mishaps. Acad Med. 2004;79(2):186–94.
Article PubMed Google Scholar
Beach C, Croskerry P, Shapiro M. Profiles in patient safety: emergency care transitions. Acad Emerg Med. 2003;10(4):364–7.
Article PubMed Google Scholar
Gandhi TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med. 2005;142:352-358. Mukherjee S. A precarious exchange. N Engl J Med 2004;351:1822–1824.
Sorokin R, Riggio JM, Hwang C. Attitudes about patient safety: a survey of physicians-in-training. Am J Med Qual. 2005;20:70–7.
Article PubMed Google Scholar
Cohen MD, Hilligoss PB: Handoffs in hospitals: a review of the literature on information exchange while transferring patient responsibility or control. 2009. https://deepblue.lib.umich.edu/handle/2027.42/61522.
Google Scholar
Shojania KG, Fletcher KE, Saint S. Graduate medical education and patient safety: a busy–and occasionally hazardous–intersection. Ann Intern Med. 2006;145(8):592–8.
Article PubMed Google Scholar
Singh H, Thomas EJ, Petersen LA, Studdert DM. Medical errors involving trainees: a study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167(19):2030–6.
Article PubMed Google Scholar
Horwitz LI, Moin T, Krumholz H, Wang L, Bradley EH. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755–60.
Article PubMed Google Scholar
Riesenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. Am J Med Qual. 2009;24(3):196–204.
Article PubMed Google Scholar
Joint Commission sentinel event statistics: as of December 2015 http://www.jointcommission.org/sentinel_event.aspx. Accessed July 2017.
Flemming D, Hübner U. How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review. Int J Med Inform. 2013;82(7):580–92.
Article PubMed Google Scholar
The Joint Commission National patient safety goals, Retrieved July 21st, 2017, from http://www.jcrinc.com/National-Patient-Safety-Goals/. Accessed July 2017.
Institute of Medicine. Crossing the quality chasm. Washington DC: National Academy Press; 2001.
Google Scholar
Manning M. Improving clinical communication through structured conversation. Nurs Econ. 2006;24(5):268–71.
PubMed Google Scholar
Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Joint Commission Journal of Quality and Patient Safety. Jt Comm J Qual Patient Saf. 2006;32(3):167–75.
Article PubMed Google Scholar
Monroe, M. SBAR: a structured human factors communication technique. Health beat. American Society of Safety Engineers. 2006; 5(3), 1–24.
Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care. 2004;13:85–90.
Article Google Scholar
Greenfield LJ. Doctors and nurses: a troubled partnership. Ann Surg. 1999;230:279–88.
Article PubMed PubMed Central CAS Google Scholar
Thomas C, Bertram E, Johnson D. The SBAR communication technique: teaching nursing students professional communication skills. Nurse Educ. 2009;34(4):176–80.
Article PubMed Google Scholar
Wachter RM, Shojania KG. Internal bleeding: the truth behind America’s terrifying epidemic of medical mistakes. New York: Rugged Land; 2004;74.
Hughes RG. Chapter 33: professional communication and team collaboration. In: Patient safety and quality: an evidence-based handbook for nurses; 2008.
Google Scholar
Townsend-Gervis M, Cornell P, Vardaman JM. Interdisciplinary rounds and structured communication reduce re-admissions and improve some patient outcomes. West J Nurs Res. 2014;36(7):917–28.
Article PubMed Google Scholar
Solet DJ, Norvell JM, Rutan GH, Frankel RM. Lost in translation: challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med. 2005;80(12):1094–9.
Article PubMed Google Scholar
Machaczek K, Whietfield M, Kilner K, Allmark P. Doctors’ and nurses’ perceptions of barriers to conducting handover in hospitals in the Czech Republic. American Journal of Nursing Research. 2013;1(1):1–9.
Google Scholar
Payne S, Hardey M, Coleman P. Interactions between nurses during handovers in elderly care. Journal of Advanced Nursing. 2000;32(2):277–85.
Article PubMed CAS Google Scholar
Dracup K, Morris PE. Passing the torch: the challenge of handoffs. American Journal of Critical Care. 2008;7(2):95–7.
Google Scholar
Solet DJ. Main barriers to effective handoffs identified. Healthc Benchmarks Qual Improv. 2006;13(2):17–9.
Google Scholar
Martín PS, Vázquez CM, Lizarraga UY, Oroviogoicoechea OC. Intraprofessional communication during shift change. Revista de enfermeria (Barcelona, Spain). 2013;36(5):22–8.
Google Scholar
The Joint Commission. Hand-off communications: standardized approach. The Joint Commission 2008 available at https://www.jointcommission.org/at_home_with_the_joint_commission/sbar_%E2%80%93_a_powerful_tool_to_help_improve_communication/. Accessed 22 July 2018.
Doucette J. View from the cockpit: what the aviation industry can teach us about patient safety. Nursing. 2006;36(11):50–3.
Article PubMed Google Scholar
Woodhall L, Vertacnik L, McLaughin M. Implementation of the SBAR communication technique in a tertiary center. J Emerg Nurs. 2008;34(4):314–7.
Article PubMed Google Scholar
Randmaa M, Mårtensson G, Swenne CL, Engström M. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study. BMJ Open. 2014;4(1):e004268.
Article PubMed PubMed Central Google Scholar
Randmaa M, Swenne CL, Mårtensson G, Högberg H, Engström M. Implementing situation-background-assessment-recommendation in an anaesthetic clinic and subsequent information retention among receivers: a prospective interventional study of postoperative handovers. European Journal of Anaesthesiology (EJA). 2016;33(3):172–8.
Article Google Scholar
Merkel MJ, Zwißler B. Structured patient handovers in perioperative medicine: rationale and implementation in clinical practice. Der Anaesthesist. 2017;66(6):396–403.
Von Dossow V, Zwissler B. Recommendations of the German Association of Anesthesiology and Intensive Care Medicine (DGAI) on structured patient handover in the perioperative setting. Anaesthesist. 2016;65(1):1–4.
Fabila TS, Hee HI, Sultana R, Assam PN, Kiew A, Chan YH. Improving postoperative handover from anaesthetists to non-anaesthetists in a children’s intensive care unit: the receiver’s perception. Singap Med J. 2016;57(5):242.
Article Google Scholar
Ting WH, Peng FS, Lin HH, Hsiao SM. The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department. Taiwanese Journal of Obstetrics and Gynecology. 2017;56(2):171–4.
Article PubMed Google Scholar
Scott J. Obstetric transport. Obstet Gynecol Clin N Am. 2016;43(4):821–40.
Article Google Scholar
Martin HA, Ciurzynski SM. Situation, background, assessment, and recommendation—guided huddles improve communication and teamwork in the emergency department. J Emerg Nurs. 2015;41(6):484–8.
Article PubMed Google Scholar
Ozekcin LR, Tuite P, Willner K, Hravnak M. Simulation education: early identification of patient physiologic deterioration by acute care nurses. Clinical Nurse Specialist. 2015;29(3):166–73.
Article PubMed Google Scholar
Panesar RS, Albert B, Messina C, Parker M. The effect of an electronic SBAR communication tool on documentation of acute events in the pediatric intensive care unit. Am J Med Qual. 2016;31(1):64–8.
Article PubMed Google Scholar
Kotsakis A, Mercer K, Mohseni-Bod H, Gaiteiro R, Agbeko R. The development and implementation of an inter-professional simulation based pediatric acute care curriculum for ward health care providers. Journal of interprofessional care. 2015;29(4):392–4.
Article PubMed Google Scholar
Raymond M, Harrison MC. The structured communication tool SBAR (Situation, Background, Assessment and Recommendation) improves communication in neonatology. SAMJ: South African Medical Journal. 2014;104(12):850–2.
Article PubMed CAS Google Scholar
Agency for Health care Research and Quality. https://psnet.ahrq.gov/search?topic=SBAR&f_topicIDs=680,711. Accessed 22 July 2017.
Australian Commission for Safety and Quality in Health Care, Australian Commission for Safety and Quality in Health Care ISBAR revisited: identifying and solving barriers to effective handover in interhospital transfer http://www.safetyandquality.gov.au/our-work/clinical-communications/clinical-handover/national-clinical-handover-initiative-pilot-program/isbar-revisited-identifying-and-solving-barriers-to-effective-handover-in-interhospital-transfer/. Accessed 22 July 2017.
Institute of Health Care improvement, April 13, 2016 http://www.ihi.org/resources/Pages/Tools/SBARToolkit.aspx.
WHO Patient Safety Solutions| volume 1, solution 3 | May 2007. www.who.int/patientsafety/solutions/patientsafety/PS-Solution3.pdf. Accessed 22 July 2017.
Ardoin KB, Broussard L. Implementing handoff communication. Journal for Nurses in Professional Development. 2011;27(3):128–35.
Article Google Scholar
Pope BB, Rodzen L, Spross G. Raising the SBAR: how better communication improves patient outcomes. Nursing2016. 2008;38(3):41–3.
Article Google Scholar
Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, Kennerly D. Implementing SBAR across a large multihospital health system. The Joint Commission Journal on Quality and Patient Safety. 2012;38(6):261–8.
Article PubMed Google Scholar
National Patient Safety Agency (Great Britain). Recognising and responding appropriately to early signs of deterioration in hospitalised patients. In: National Patient Safety Agency; 2007.
Google Scholar
De Meester K, Verspuy M, Monsieurs KG, Van Bogaert P. SBAR improves nurse-physician communication and reduces unexpected death: a pre and post intervention study. Resuscitation. 2013;84(9):1192–6.
Article PubMed CAS Google Scholar
Wong HJ, Bierbrier R, Ma P, Quan S, Lai S, Wu RC. An analysis of messages sent between nurses and physicians in deteriorating internal medicine patients to help identify issues in failures to rescue. Int J Med Inform. 2017;100:9–15.
Article PubMed Google Scholar
Salzwedel C, Bartz HJ, Kühnelt I, Appel D, Haupt O, Maisch S, Schmidt GN. The effect of a checklist on the quality of post-anaesthesia patient handover: a randomized controlled trial. Int J Qual Health Care. 2013;25(2):176–81.
Article PubMed Google Scholar
Funk E, Taicher B, Thompson J, Iannello K, Morgan B, Hawks S. Structured handover in the pediatric postanesthesia care unit. Journal of PeriAnesthesia Nursing. 2016;31(1):63–72.
Article PubMed Google Scholar
McCrory MC, Aboumatar H, Custer JW, Yang CP, Hunt EA. “ABC-SBAR” training improves simulated critical patient hand-off by pediatric interns. Pediatr Emerg Care. 2012;28(6):538–43.
Article PubMed Google Scholar
Lee SY, Dong L, Lim YH, Poh CL, Lim WS. SBAR: towards a common interprofessional team-based communication tool. Med Educ. 2016;50(11):1167–8.
Article PubMed Google Scholar
Cornell P, Gervis MT, Yates L, Vardaman JM. Impact of SBAR on nurse shift reports and staff rounding. Medsurg Nurs. 2014;23(5):334–43.
PubMed Google Scholar
Vardaman JM, Cornell P, Gondo MB, Amis JM, Townsend-Gervis M, Thetford C. Beyond communication: the role of standardized protocols in a changing health care environment. Health Care Manag Rev. 2012;37(1):88–97.
Article Google Scholar
Renz SM, Boltz MP, Wagner LM, Capezuti EA, Lawrence TE. Examining the feasibility and utility of an SBAR protocol in long-term care. Geriatr Nurs. 2013;34(4):295–301.
Article PubMed PubMed Central Google Scholar
Horwitz LI, Moin T, Green ML. Development and implementation of an oral sign-out skills curriculum. J Gen Intern Med. 2007;22:1470–4.
Article PubMed PubMed Central Google Scholar
Ilan R, LeBaron CD, Christianson MK, Heyland DK, Day A, Cohen MD. Handover patterns: an observational study of critical care physicians. BMC Health Serv Res. 2012;12:11.
Article PubMed PubMed Central Google Scholar
JM A, Osborne-McKenzie T. Advancing the evidence base for a standardized provider handover structure: using staff nurse descriptions of information needed to deliver competent care. J Contin Educ Nurs. 2012;43(6):261–6.
Article Google Scholar
Lazzara EH, Riss R, Patzer B, Smith DC, Chan YR, Keebler JR, Fouquet SD, Palmer EM. Directly comparing handoff protocols for pediatric hospitalists. Hospital pediatrics. 2016;6(12):722–9.
Article PubMed Google Scholar

Page 2

From: Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for Handoff in Health Care – A Narrative Review

Authors	Year	Country	Study design	Study characteristics	Results
Haig et al [16]	2006	USA	Pre- and post-intervention study	Nursing staff in Bloomington, Illinois. A telephone survey of 10 nurses prior to the intervention. The intervention included an education session on SBAR tool and its implementation for handoff. Methods for collecting post-intervention data not described	Increase in use of SBAR by 95%, improvement in admission medication reconciliation from mean of 72% to a mean of 88% and discharge reconciliation from a mean of 53% to a mean of 89%, and reduction in adverse events from 89.9 per 1000 patient days to 39.96 per 1000 patient days
Compton et al [51]	2012	USA	Survey	Baylor Health Care System initiated a campaign to implement SBAR and train staff in SBAR techniques across 13 hospitals. 156 nurses interviewed after implementation of SBAR package with the nurse audit tool	97.4% nurses had been educated about SBAR and 58.3% used SBAR for critical communication only. 73% of nurses demonstrated good or high proficiency. Among the nurses who did not use SBAR, the leading reason was lack of comfort with SBAR. 78% of physicians reported they received adequate information from nurses regarding patient condition
Meester et al [53]	2013	Belgium	Pre- and post-intervention study	16 hospital ward nurses of Antwerp University Hospital were trained to use SBAR to communicate with physicians in cases of deteriorating patients. Patient records were checked for SBAR items up to 48 h before a SAE.	There was increase in the use of all 4 components of SBAR by 34%, total score on the questionnaire increased in nurses ({from 58 (range 31–97) to 64 (range 25–97)}; p < 0.001), the number of unplanned in ICU admissions increased ((from 13.1/1000 to14.8/1000) admissions; relative risk ratio = 50%; 95% CI 30–64; p = 0.001) and unexpected deaths decreased from 0.99/1000 to 0.34/1000 admissions; RRR = − 227%; 95%CI − 793 to − 20; NNT1656; p < 0.001)
Wong et al [54]	2017	Canada	Retrospective chart review	Chart review of all ICU transfers from General Internal Medicine (GIM) wards of Toronto General Hospital	Out of a total of 615 messages for 179 of the 236 patients, 93 (39%) patients had a CM in the 48 h prior to ICU transfer. 13 patients (17%) did not have RRT activation prior to transfer to ICU and 63 (83%) patients had delayed RRT activation after the CM. In the subgroup of 63 patients with delayed RRT activation, the only significant correlation (p = 0.047) with in-hospital survival was the number of SBAR components in the CM.
Fabila et al [37]	2016	Singapore	Prospective interventional study	A total of 52 CICU personnel participated in the study which include 7 pediatric consultants, 1 rotating pediatric registrar, and 44 nurses working in shifts at KK Women’s and Children’s Hospital (KKH)	There was a significant increase in the proportion of nurses who indicated that information transfer during verbal face-to-face handover was frequently sufficient, as compared to the pre-intervention phase (95.5 vs. 31.8%; difference 63.7%; 95% CI 51.4–81.8%; p < 0.0001). Overall, the perceived usefulness of SBAR document during handovers significantly increased by about 33.0% (95% CI 15.0–53.0%; p = 0.0004).
Funk et al [56]	2016	USA	Pre- and post-intervention study	52 pre-implementation handovers and 51 post-implementation handovers were observed at PACU of Duke University Medical Center	There was a statistically significant increase in the percentage of use of ISBARQ items (p < 0.001) and provider’s satisfaction (p < 0.01) from pre-implementation to post-implementation and no significant change in duration of handoff (mean = 5.80 ± 3.80 min) to post (mean = 6.80 ± 2.30 min), p = 0.15.
Panesar et al [42]	2016	USA	Prospective study	84 patient events were recorded from 542 admissions to the pediatric intensive care unit of Stony Brook Children’s Hospital. 3 time periods were studied: (1) paper documentation only, (2) electronic documentation, and (3) electronic documentation with SBAR template.	There was an increase in the frequency of critical patient event notes but not statistically significant (p = .07) and improvement in quality scores significantly from paper documentation to electronic SBAR-template notes. Moreover, 100% documentation of nurse and attending physician communication was achieved during electronic SBAR note period.
Ting et al [38]	2017	Taiwan	Pre- and post-intervention study	The SBAR course was offered as a 1-h session by obstetricians annually at Far Eastern Memorial Hospital from 2012 to 2015. All nurses were asked to answer the Safety Attitudes Questionnaire (SAQ) before and after the intervention. 6 safety dimensions of SAQ were assessed which include teamwork climate, safety climate, job satisfaction, stress recognition, perception of management and working conditions	29 nurses completed the pre-intervention survey, 34 completed the first post-intervention survey, and 33 completed the second post-intervention survey. There was improvement in the value ratings for teamwork climate (p = 0.002), safety climate (p = 0.01), job satisfaction (p = 0.002), and working condition (p = 0.02).
McCrory et al [57]	2012	USA	Pre- and post-intervention study	Each of the 26 pediatrics interns at John Hopkins University reviewed a scenario involving a decompensating pediatric patient and gave a simulated handoff to a responder. A didactic session on ABC-SBAR was given, then performed a second handoff using another scenario. A total of 52 handoffs were included for analysis.	The mean score of handoffs increased after ABC-SBAR training (from 3.1/10 to 7.8/10; p < 0.001). Handoff report of the airway, breathing, and circulation increased (from 35 to 85%; p = 0.001) after the training, the information was also shared earlier (25 vs. 5 s; p < 0.001) in post-intervention period. Total handoff duration was increased (pre-intervention 29 s vs. post-intervention 36 s, p = 0.004).
Townsend- Gervis M et al [23]	2014	USA	Prospective study	111 nurses participated from 3 medical and surgical unit of Baptist Memorial Health Care Corporation .Nurses used SBAR in a variety of circumstances, including shift reports and physician rounds (both paper and electronic copy of SBAR was available for patient presentation)	Over the 3-year period, Foley compliance improved (from 78 to 94%; p < 0.001) and re-admissions decreased (from 14.5 to 2.1%; p < 0.001), both significant. Patient satisfaction trended positively but was not significant
Vanderman et al [60]	2012	USA	Qualitative case study	Nurses had received training in SBAR for use primarily in communication with physicians. Data were collected from 80 semi-structured interviews with nurses (n = 66), nurse manager (n = 9), and physicians (n = 5), and observations were made on nursing, other hospital activities, and documents that related to the implementation of the SBAR protocol.	SBAR tool has impact on schema formation (quick decision making when bombarded with load of information), development of legitimacy, development of social capital (networking), and reinforcement of dominant logics in addition to improvement in nurses and physician communication
Renz SM et al [61]	2013	USA	Pre- and post-intervention study	137 bed skilled nursing home, part of a faith-based continuing care retirement community in suburban Pennsylvania. 40 nurses participated in pre-intervention phase and 32 participated in post-intervention phase	87.5% of nurses found SBAR tool useful to organize information when communicating to medical providers. 78% (n = 51) had complete documentation, while the remaining 22% (n = 14) had some missing documentation. The physician reported improvement in the quality of nurse-physician communication related to change in resident condition after implementation of the project