International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 530

Original Article

The Situation, Background, Assessment and Recommendation (SBAR)

Model for Communication between Health Care Professionals: A
Clinical Intervention Pilot Study

Lisbeth Blom, MSc, RNs

Junior Lecturer, The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad,
Sweden

Pia Petersson, PhD, RN,

Senior Lecturer, The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad,
Sweden

Peter Hagell, PhD, RN

Professor, The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden

Albert Westergren, PhD, RN

Professor, The PRO-CARE Group, School of Health and Society, Kristianstad University, Kristianstad, Sweden

Correspondence: Dr Lisbeth Blom, Kristianstad University, SE-291 88 Kristianstad, Sweden

E-mail: [email protected]

Abstract
Background: SBAR has been suggested as a means to avoid unclear communication between health care
professionals and in turn enhance patient safety in the healthcare sector.
Aim: to evaluate hospital-based health care professionals experiences from using the Situation, Background,
Assessment and Recommendation (SBAR) communication model.
Methodology: A quantitative, descriptive, comparative pre- and post-intervention questionnaire-based pilot
study before and after the implementation of SBAR at surgical hospitals wards. Open comments to
questionnaire items were analyzed qualitatively.
Results: The introduction of SBAR increased the experience of having a well-functioning structure for oral
communication among health care professionals regarding patients’ conditions. Qualitative findings revealed the
categories: Use of SBAR as a structure, Reporting time, Patient safety, and Personal aspects.
Conclusions: SBAR is perceived as effective to get a structure of the content in patient reports, which may
facilitate patient safety.

Key Words: SBAR, communication, health care professionals, patient safety.

Background common understanding (Greenberg et al., 2007).

Without a common understanding there is a risk that
Unclear and ineffective communication between
the basis for healthcare professionals to make correct
health care professionals is a common underlying
assessments and appropriate decisions is lacking.
cause of patient injuries in healthcare (Gawande,
Zinner, Studdert, & Brennan, 2003). Therefore, the The Situation, Background, Assessment and
transfer of information between health care Recommendation (SBAR) model has been suggested
professionals is very important. If the information is as a means to facilitate effective communication
unclear, there is a risk that it does not create a between health care professionals (Beckett & Kipnis,

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International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 531

2009). SBAR is a well-tested model (Instititute for Data collection

Healthcare Improvement, 2015), which has been
The questionnaire was developed specifically for this
used for a long time for transmission of important
study by two of the authors (LB and AW) based on
information in complex work environments, for
previous personal and reported experiences (Wallin
example in the nuclear industry, aviation and
& Thor, 2008). The questions focused on how health
NASA's space program (Wallin & Thor, 2008).
professionals experienced the current communication
SBAR provides a framework for communication
structure (Table 1).
between members of the health care team about a
patient's condition, and has been found to facilitate Intervention
both the collection, organization, and exchange of The aim of introducing the SBAR model was to
information as well as be an effective strategy to increase focus on patient safety when communicating
develop teamwork (Leonard, Graham, & Bonacum, information, while also saving time by enhancing the
2004). structure of the information.
Studies show that there are many advantages to using When introducing SBAR, the specific content of the
a standardized model such as SBAR when model needs to be adjusted to the relevant context
communicating regarding patients (Beckett & Kipnis, (Ko CH, Turner, & Finnigan, 2011). Therefore, a
2009; Novac & Fairchild, 2012; Whittingham & working group was formed, composed of nurses, a
Oldroyd, 2014). It provides an opportunity to physician, and one of the authors. Based on existing
maintain focus in the information transfer and to literature the working group presented two pocket-
keep the information concise, accurate and easy to sized SBAR-based reference cards, one for
understand (Novac & Fairchild, 2012). Patient safety communication when reporting between shifts and
will also be facilitated by having a structure for the one for communication in instances of impaired
information content when communicating regarding patient status/needs for immediate medical
patients (Beckett & Kipnis, 2009; Novac & Fairchild, consultation with a physician (Figure 1).
2012), by serving as a reminder as to what should be
communicated (Beckett & Kipnis, 2009). Procedures
Aim Approvals from the hospital's chief medical officer
and head nurses at the included wards were sought
The aim was to evaluate hospital-based health care and received before initiating the project.
professionals’ experiences from using the Situation,
Background, Assessment and Recommendation All staff received oral and written information about
(SBAR) communication model. the aim of the project. They were then asked to
individually complete the study questionnaire before
Methodology the introduction of the SBAR model. When
This pilot study had a quantitative, descriptive, implementing the SBAR model all health care
comparative pre- and post-intervention design. Data professionals at the included wards received oral and
were collected before and after the introduction of written information about how the SBAR model
SBAR by a structured questionnaire with the would be used, and the SBAR reference cards were
possibility of commenting in free text (Polit & Beck, made available to all staff. All health care
2004). professionals at the included wards were asked to
complete the study questionnaire a second time, one
Context and participants
year after the implementation of the SBAR model.
The study was conducted at two surgical and one The questionnaires were coded and no personal
orthopedic ward, each with 26 beds, at a hospital in information was collected; reminders were sent to
southern Sweden. The sample included all enrolled non-responders after X weeks.
nurses, registered nurses and physicians (n=189) who
Data analysis
were employed at the wards. No specific
communication model was used at the included units Since pre-intervention responders could not be linked
before this study. to pre-intervention responders, questionnaire data

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International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 532

from the two time points were treated as independent particularly when nurses reported to physicians
groups. Thus, quantitative data were analyzed using substituting for patients’ regular responsible
the Mann-Whitney U-test. P-values of <0.05 was physician. It was proposed that patient safety can be
considered significant. Written comments were enhanced by supplementing oral communication with
analyzed qualitatively according to conventional available written documentation.
content analysis (Hsieh & Shannon, 2005).
Personal aspects
Results
Nursing staff felt that the success of the SBAR model
The questionnaire was answered by 116 staff to improve communication between staff was
members before and 86 after the implementation of dependent on the person communicated. For
the SBAR model. A larger proportion of the staff example, the ability of the SBAR model to facilitate
reported that they found the structure and content of patient safety was considered related to exactly what
oral communication regarding patients efficient after was reported regarding a patient's condition. Other
as compared to before the introduction of the SBAR aspects related to the person reporting were the time
model; no other differences were found (Table 1). taken for reports and compliance to the SBAR
The written comments showed four themes: Use of model. Furthermore, the extent to which staff felt
SBAR as a structure; Reporting time; Patient safety respected for their knowledge and skills varied. For
and Personal aspects. example, one nurse felt that physicians did not
always respect her competence.
Use of SBAR as a structure
Discussion
The majority of nursing staff described that SBAR
was "very helpful" and provided a good structure to This pilot study aimed at evaluating health care
use in oral reporting on patients' conditions. Some professionals’ experiences of communication before
respondents felt that they always had reported in a and after the implementation of the SBAR model at
similar manner already before, so the introduction of three hospital wards. The study showed that SBAR
SBAR was not seen as something new. There were was perceived to be a good structure to use when
some who had not used the model after its reporting patients' conditions. This was also shown in
introduction, which mainly was due to forgetting to the study by Beckett and Kipnis (2009).
use it. One of the nursing staff did not think the ward
actively used the SBAR model as intended. However, some nurses in this study indicated that it
sometimes took longer time to report when using the
Reporting time SBAR model. This could be seen as negative but
The time taken for patient reporting was in part may also mean that time was spent on ensuring that
considered dependent on the person reporting. Some important aspects were reported and that nothing was
felt that the time for reporting had decreased since missed (Whittingham & Oldroyd, 2014). The study
the SBAR structure "taught them to report correctly", shows that SBAR was considered to facilitate patient
while others felt that this took equally long or longer, safety. SBAR can be seen as a checklist to ensure
but that the SBAR structure provided more efficient that all significant aspects will be covered when
communications. communicating patient reports, which may contribute
to patient safety. Although patient care should be
Patient safety safe, indirectly we found indications of deficiencies
Patient safety was considered promoted by the SBAR in patient safety. For example, when the SBAR
model since it reduces the risk that certain aspects are model was not used, which led to a risk that
missed when reporting. Sometimes staff experienced important information was not communicated. It is
some deficiencies in patient safety in the oral important that all members of the health care team
communication between health professionals, take responsibility when introducing a new model.

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Assess the patient, Read medical records, Have current information from medical records available

Reports between shifts Impaired patient status/needs for

immediate medical consultation
Situation Describe: Describe:
S Current problem  Room/bed number  Own name and ward
 Patient's name and date of birth  Patient's name and date of birth
 Date of admission  Current problem
 Reason for admission  Current status
 Modified Early Warning Score (MEWS)
 Saturation/oxygen
 Visual Analogue Scale (VAS) value if at
pain
Bakground Describe: Describe:
B Provide brief  Relevant medical history  Reason for admission
medical history  Social background  Date of admission
and overall  Level of care  Relevant medical history
summary of the  Any allergies/hypersensitivities  Brief summary of current problem and
situation. treatment
 The patient´s
o Mental status: awake, orientation
regarding person, time and place
o Skin: warm, cold, dry, marbled,
pale
o Distal status
o Neurological signs, weakness
o Pain
o Wounds/drainage
o Nutrition: nausea, vomiting,
eating/fasting
o Elimination: urine/faeces
Assessment Brief report on current nursing status and I think the problem is:
A What do you care:  Cirkulatory
think is the  Communication  Infection
problem  Breathing/circulation  Neurological
 Nutrition  Respiratory
 Elimination I don't know what the problem is but the patient is
 Skin worsened.
 Activity The patient seems unstable and may deteriorate,
 Sleep something must be done.
 Pain
 Psychosocial
 Risk assessments: falls, pressure
ulcers, etc.
Recom- Suggested recommendations: Suggested recommendations:
R mendation  Planning  Come and assess patient now
Provide a  Discharge plans  Come and assess patient within 30-60 min
recom-  Transfer patient to ICU
mendation  Contact next of kin regarding the status
regarding what  Other suggestions
should be done Inquire regarding need for monitoring/assessments:
based on the  X-ray, ECG, blood gas, pulse and blood
situation, pressure, respiration, saturation, other
background and Inquire regarding continued management:
assessment  How often should vital parameters be
reported?
 How long can the problem be expected to
maintain?
 If the patient doesn't improve, within what
time should I call again?
Figure 1: Merged contents of the two pocket-sized SBAR-based reference cards (for reporting between shifts and
for instances of impaired patient status/needs for immediate medical consultation with a physician, respectively)
used for the transfer of information between health care professionals.

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Table 1. Sample characteristics and questionnaire responses before and after

introduction of the SBAR model a
Before After P-value b
(n=116) (n=86)
Age (years), % 0.950
21-30 22.4 19.8
31-40 25.9 22.1
41-50 20.7 24.4
51-60 22.4 24.4
>60 8.6 9.3
Number of years in profession, % 0.748
<1 8.8 4.8
2-5 20.4 19.3
6-10 15.9 21.7
11-15 6.2 7.2
16-20 6.2 3.6
>21 42.5 43.4

Today's oral communication ensures high patient security c 3 (2-3) 3 (2-3) 0.257

I feel confident in what should be reported to 3 (3-3) 3 (3-3) 0.531

physicians/nurses/enrolled nurses regarding patient safety d

Today's oral communication regarding patients’ conditions is 3 (3-4) 3 (3-4) 0.587

based on respect for each other's expertise in the sense that I
respect other professions' knowledge c

Today's oral communication regarding patients’ conditions is 3 (3-3) 3 (3-3) 0.850

based on respect for each other's expertise in the sense that my
expertise is respected by other professions c

We have an efficient structure of the content of oral 3 (2-3) 3 (3-3) 0.001

communication regarding patients' conditions c
Strongly disagree, % 0 1.2
Disagree, % 16.5 8.3
Neither agree or disagree, % 32.2 11.9
Agree, % 45.2 70.2
Strongly agree, % 6.1 8.3

When I receive a verbal report on a patient, I get a good 3 (3-3) 3 (3-3) 0.624
overview of the patient's condition c

When I receive a verbal report on a patient's condition, I am 2 (2-3) 3 (2-3) 0.748

usually also recommended what to do c

a
Dta are median (q1-q3) unless otherwise noted.
b
Mann-Whitney U test. Md = median, Q1-Q3 = interquartile ranges.
c
0 = Strongly disagree; 1 = Disagree; 2 = Neither agree or disagree; 3 = Agree; 4 = Strongly agree.
d
0 = Never; 1 = Rarely; 2 = Sometimes; 3 = Often; 4 = Always

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International Journal of Caring Sciences September-December 2015 Volume 8 | Issue 3| Page 535

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