SBAR provides a standardized framework for physician-nurse communication.
Good communication between physicians and nurses is essential to developing an effective plan of care for each patient. But difficulties may arise because physicians and nurses are trained differently.
Creating A Common Language
"Nurses learn to give a narrative, while doctors are taught to give information in bullet points," explains Lek Kremer, nurse manager of the trauma unit at Regions Hospital (www.regionshospital.com).
To overcome this language barrier, clinicians at Kaiser Permanente (www.kaiserpermanente.org), borrowing concepts developed by the nuclear submarine service, created SBAR, a standardized approach to communication. SBAR stands for Situation, Background, Assessment and Recommendation.
According to the Institute for Healthcare Improvement (www.ihi.org), SBAR is especially useful during critical events, shift handoffs or patient transfers.
SBAR In Action
Mr. Jones, a patient in room 235, begins experiencing chest pain during the night. The bedside nurse calls his physician and, instead of giving a long narrative, uses SBAR to provide a brief, but thorough report.
Situation: Mr. Jones is experiencing chest pain.
Background: He is an 80-year-old man admitted through the ER yesterday with pneumonia. He has a history of hypertension and coronary artery disease. His pulse is 120, and his blood pressure is 140 over 90. His pain is between four and six on the pain scale, and it's radiating to the left. An EKG done at 3 p.m. was normal. I've given him aspirin per standing orders and am administering oxygen.
Assessment: He is experiencing severe chest pain that needs further evaluation.
Recommendation: I'd like you to come and see Mr. Jones right away. Is there anything I should do before you arrive?
Physicians know what information they can expect from the nurses, and nurses know how to organize that information effectively. "The use of SBAR allows everyone to be on the same page," Kremer says. "It builds trust, emphasizes collaboration and enables bedside nurses to make suggestions based on their clinical expertise and experience with the patient.
Nancy Gigure is a freelance writer from St. Paul who has written about healthcare since 1995.