Situation, Background, Assessment,
Recommendation (SBAR) Communication
Tool for Handoff in Health Care
-BY THE DEPT. OF CCM BBH
HANDOVER
the definition by Cohen et al. in a recent literature review (“the exchange between health
professionals of information about a patient, accompanying either a transfer of control over, or
of responsibility for, the patient”
BACKGROUND
A handoff between health care providers is the key factor
in fostering continuity of care and providing safe patient
Care
The Joint Commission
reviewed a total of 936 sentinel events during the
year of 2015; communication was identified as the root
cause in more than 70% of serious medical errors.
COMMON PROBLEMS
medication errors, inaccurate patient plans,
Delay in transfer of a patient to critical care,
delay in hospital discharge
repetitive tests .
AIM
To review the challenges of communication among health
care providers in clinical setting,
To review the use of the standardized Situation, Background, Assessment, Recommendation
(SBAR) communication tool during handoff.
To compare the SBAR tool with other communication
tools to assess the communication during patient handoff.
COMMON CHALLENGES IN HANDOVER
Health care providers need to be cognizant of the challenges facing handoffs,
including physical setting, social setting, language barriers, and communication
barriers .
Environmental obstacles:-
Distractions, insufficient time, and interruptions .
Lighting, background noise, television/computer screens,
Crowding, or busy nursing stations .
Avoid these preventable distractions, it is recommended that nurses and other health
care providers share patient information in designated areas away from distraction.
COMMON CHALLENGES IN HANDOVER(CONTD.)
HISTORY:
SBAR was first developed by the military, specifically for nuclear submarines. It was then used in the aviation
industry, which adopted a similar model before it was put into use in health care.
It was introduced to rapid response teams (RRT) at Kaiser Permanente in Colorado in 2002, to investigate
patient safety. The main purpose was to alleviate communication problems traced from the differences in
communication styles between healthcare professionals. SBAR was later adopted by many other health care
organizations.
It is now widely recommended in healthcare communication. For instance, the Royal College of Physicians of
London, UK, recommends the use of SBAR during the handover of care between medical teams when treating
patients who are seriously ill or at risk of deteriorating.
SBAR is an included tool in the Interventions to Reduce Acute Care Transfers (INTERACT II) project, a US
measure to reduce rehospitalization among residents of long-term care (LTC) facilities.
What more to ask??
Reason for ICU?
Any events in the near past?
i/o
Abnormal blood/body fluids tests?
Any problem with the relatives?
Diet
PROS AND CONS OF SBAR
CONS
PROS
Limitations of SBAR tool The SBAR tool requires
• Accurate and relevant information to be shared
training of all clinical staff so that communication
• Better patient experience is well understood.
• Credibility of nursing handover It requires a culture change to adopt and sustain
structured communication formats by all health
• Better decision making by medical staff
care providers.
• Appropriate prioritisation of patients If the recipient is unfamiliar with the concept of
• Improved time management SBAR
HOW TO IMRPOVE THE HANDOVERS??
Tenet is to avoid reliance on memory .
Memory aids
simple note-taking process during handovers
“low-tech” solutions, such as electronic documents that exist locally in the ICU
computer,
complex handover systems that integrate with electronic medical records
OTHER METHODS
A systematic review of handover mnemonics resulted in the
identification of twenty-four different mnemonics up to 2009.
The best evidence comes from a recent before-after study of a new
mnemonic (I-PASS), where the use of standardization resulted in a
23% decrease in medical errors in a pediatric population.
Six-Sigma, or from Formula-One from the automotive industry to
improve handovers to the ICU.
I-PASS
I-PASS –AIMS AND BACKGROUND
Aim- to determine the effectiveness of implementing a “resident handoff bundle” to standardize
inpatient transitions in care and decrease medical errors in 10 pediatric institutions. The resident
handoff bundle includes 3 major elements:
team training by using focused TeamSTEPPS communication strategies,
implementation of a standardized template for the written or printed computerized handoff document
introduction of several evidence-based verbal handoff processes, which are referred to by using a novel verbal
mnemonic.
Background-Communication errors are a contributing cause of approximately two-thirds of sentinel
events, over half of which involve handoff failures.
In health care, the magnitude of the patient safety epidemic first became widely recognized with the
publication of To Err Is Human in 1999, which concluded that medical errors cause up to 98 000
preventable deaths annually in the United States.
I-PASS
We focused on elements that pilot study faculty observers noted
were most commonly absent from resident handoffs (illness severity
assessment, contingency planning, and read-back by the receiving
resident) and incorporated best practices for verbal handoffs from
our review of existing literature.
The results of this session led to the development of a novel
mnemonic, I-PASS , which serves as the cornerstone for the resident
handoff bundle that is currently being implemented and tested in the
I-PASS study.
DEVELOPMENT
The use of the SIGNOUT mnemonic, which was shown to increase the consistency and
confidence with which residents perform verbal sign-outs, as compared with an implicit,
informally structured process.
However, they found that a majority of verbal handoffs did not adhere to the structure of
the SIGNOUT mnemonic.
Due to the successes and challenges of SIGNOUT, they considered use of the mnemonic,
IPASSTHEBATON from TeamSTEPPS. Feedback from chief residents who had been
involved in the pilot curriculum, however, expressed the need for a mnemonic that was
shorter, easier to remember, and had discrete elements without overlap.
They modelled the process used to design the original SBAR mnemonic. The results of this
session led to the development of a novel mnemonic, I-PASS
EXAMPLE:-
CONCLUSION
Handovers are an important moment in patient safety with potential to improve quality and
efficiency of care. Understanding that handovers should not be a one-way communication
is crucial when caring for complex patients, such as critically ill patients.
Clinicians and intensive care unit directors should consider many simple strategies that can
improve communication and are unlikely to cause harm, despite limited evidence.
THANK YOU!
REFERENCES
Rev Bras Ter Intensiva. 2017;29(2):121-123
Shahid and Thomas Safety in Health (2018) 4:7 https://doi.org/10.1186/s40886-018-0073-1
https://www.medprodisposal.com/blog/sbar-examples/
http://www.ipasshandoffstudy.com/home
https://en.wikipedia.org/wiki/SBAR
