SBAR and Communications with Medical Professionals

If you are a nursing student or new nurse, you may be asking yourself, “What is SBAR?” In this article, we are going to breakdown the SBAR acronym and examine why it’s important. The way you communicate with medical professionals matters so much. In fact, it can be the difference between life and death for your patients at times. But let’s not get too dramatic yet. Lastly, I want to show you how it can not only help you communicate with other medical professionals, but gain their mutual trust and respect as well.

So what is the SBAR acronym? It stands for situation, background, assessment, and recommendation. If you begin that important conversation with a medical professional using this acronym and follow those four steps in order, you will convey your concern in a thorough yet concise manner. This helps your concern seem well constructed and also helps portray you in a confident light.

Situation

To kick off the conversation, first you’ll want to verify you are speaking with the intended person and then introduce yourself (name, title, location you’re calling from) and which patient you’re calling about. If you feel it’s necessary, you can throw an estimate of the amount of their time you’ll be taking to speak with them about the issue. This may seem simple, or you may feel completely lost. To help you better understand the situation portion, let’s look at an example:

“Good morning, am I speaking with Dr. Smith?” (Pause for acknowledgement) “My name is Andra, and I’m a nurse from ABC Healthcare in the ICU. I just need a moment of your time to address a concern I have about one of your patients, Mrs. Allen.”

Background

Typically in this section of the communication, you’ll want to help remind the provider of whom you are speaking. This can include disclosing their admission date, pertinent medical history, and major events of their admission. The purpose of providing this information is to refresh the provider’s mind about the patient and set them up for your assessment, cause for concern, and recommendation based on that assessment data. Again, let’s see an example of this step in the SBAR acronym:

“She was admitted on December 3rd after coming to the ER with complaints of chest pain. She was diagnosed with unstable angina and has history of hypertension, atrial fibrillation, high cholesterol, and diabetes. Since admission, she has been complaining of intermittent chest tightness.”

Assessment

During the assessment portion of the SBAR mnemonic, you’ll be using this time to disclose the current issue at hand, any associated signs/symptoms/labs, any other data you deem to be pertinent, and a most recent set of vitals. You have the provider’s attention in this moment, use it to your advantage to give them only the information related to the reason for your call. Being thorough and concise can work to your advantage here, because it shows you are a competent nurse with the ability to critically think and communicate effectively. Shall we examine another sample?

“After assessing her, I have noted SOB when laying flat, is now requiring supplemental oxygen at 4L NC, persistent chest tightness, irregular heart rhythm with slight tachycardia. She is afebrile, has a HR of 115, BP 95/68, RR 26, and O2 sat 90% on 4L NC.”

Recommendation

The recommendation stage of the SBAR is the final step and competitively the most crucial step along with the assessment. In this part of the conversation, you’ll make a request for any meds/labs/treatments you think may help improve your patient’s status. This may even include transferring the patient to a higher level of care if necessary. What do you think Mrs. Allen might need preliminarily in this situation? Let’s take a look:

“Based on this assessment data, I think it would be in her best interest to obtain a 12 lead ECG, troponins, an echo, and possibly upgrade her to the cardiovascular ICU for more close monitoring. Are there any orders you’d like me to execute at this time for her?”

After the provider issues their orders, confirm everything back to them word for word. Once confirmed, thank them for their time. When you receive any orders to check labs and replace electrolytes, be sure to repeat the test after those medications are given to see if there was a therapeutic response. You’ll want to monitor and trend their results to determine if there is improvement or deterioration (which would warrant further intervention).

Now, let’s wrap this up by discussing a few major points about using the SBAR mnemonic to communicate with healthcare providers. It will take time and experience to understand the clinical presentation of many conditions and types of patients. Utilize the knowledge you gain through your first few years as a nurse to best advocate for your patient so a worsening state of health can be prevented.

Unfortunately, you have to work hard to gain the trust and respect of other healthcare providers. This can be difficult to do when they may only be present on the unit for mere minutes at a time. Anticipate your needs and your patients’ needs before the providers round, and jot them down on your clipboard or on a note kept in your pocket. Know their most recent labs, have an idea of their vitals trends, and any test/procedural results that were pending. Being prepared and knowing your patient as completely as possible will go a LONG way in helping establish your competency, intelligence, and rapport with the providers. Once this happens, you’ll be able to contact them and they will accept your assessment sincerely and typically give you what you need/want for your patient (unless, of course, it’s out of the question in the first place).

The reputation you establish can make or break your experience on the unit with that group of healthcare providers. Utilize the SBAR mnemonic, gather assessment data like you’ve been trained to do, know your patient’s current and past medical history as thoroughly as possible, and convey your concerns with confidence. Oh, and a last little tidbit… a smile and personalized greeting goes a long way in portraying yourself in a better light in a provider’s eyes too. When they round on the unit, smile, acknowledge them by name, and ask how they’re doing. Make time for them and they will likely make time for you too, even if for a moment – because, it may just be the moment you and your patient need.

Until next time, happy studying!

Andra