Effectiveness of SBAR in Facilitating Safe Transfer of Critical Patient Information

Introduction
To deliver quality care, patient safety is one of the important aspect. WHO defined patient safety
as the decrease of risk of unnecessary harm related to healthcare to an appropriate minimum
(World Health Organisation, 2009). The effect of patient safety on the quality of healthcare is
frequently indicated by the occurrence of adverse events. One of the reports suggested that poor
communication is a source of adverse events in over 60% of all adverse events at the hospital
settings (The Joint Commission, 2014). Poor or ineffective communication can be seen in several
healthcare facilities and is specifically noticeable in patient hand-overs and in divisions where
quick and efficient management is crucial. These divisions include perioperative period, ICU and
the emergency departments. Communication has various elements and processes which are
complex and can be easily misunderstood. These barriers can be overcome by devising certain
communication strategies which are not time-consuming, do not require much effort and at the
same time offer detailed information effectively, promote inter-professional partnership and
restrict the likelihood of error. SBAR (situation, background, assessment, recommendation)
framework is a communication tool which fulfil these needs. Various derivatives of SBAR
include ISBAR, SBAR-R, ISBARR and ISOBAR. SBAR is used widely in a range of healthcare
settings as a communication and hand-off tool (Dossow & Zwissler, 2016). SBAR has a clear
structure which ensures delivery of all suitable information, planned in a logical manner. In
addition, it facilitates the preparation process prior to commencement of communication. SBAR
communication tool is currently considered the ‘best practice’ for provision of information in
critical situations. It is the gold standard handoff structure which was originally formulated and
used by the US Navy at the time of submarine duty handoff. In the SBAR communication tool S
is Situation which denotes the reason of calling the physician, B is for Background which
signifies the background information, A is the Assessment which refers to the assessment of the
issue and R is the Recommendation which is the way in which the problem should be corrected.
SBAR tool was first introduced in a healthcare facility at Kaiser Permanente in 2003 as a tool for
organizing the conversations between physicians and nurses regarding scenarios which needed
immediate attention. However, certain challenges in its use are also observed. This review is
conducted to evaluate and analyse the literature to find out the effectiveness of SBAR in

facilitating prompt and safe transfer of critical patient information by healthcare professional to
reduce preventable errors.
PICO format
For evidence-based practice, developing an answerable question is necessary to ensure quality
searching. A well-formulated question can enable the search for evidence and will assist in
ascertaining whether the evidence is relevant to the question. An answerable question is
developed using the PICO format.
P Population,
Patient/ Problem
Healthcare professionals
I Intervention SBAR
C Comparison None
O Outcome Facilitation of prompt and safe transfer of critical
patient information to reduce preventable errors
Research question
How effective is the SBAR handover in facilitating prompt and safe transfer of critical patient
information by healthcare professional to reduce preventable errors. It was trialed in South
Australia, West Australia and Victorian regions. It was found useful by 80% of respondents
noting that handover had improved and reporting more confidence when communicating with
doctors (Department of Health, 2015).
For Annotated bibliography see appendix 1.
Literature Review
Communication breakdown has been documented as the major contributor of errors in the
literature which lead to patient harm. Patient safety is one of the vital aspect of patient care. It is
observed that healthcare professionals try to prevent the occurrence of communication errors at
the time of patient handoff. Ineffective flow of communication or poor communication
breakdown is a chief cause of occurrence of preventable errors in clinical routine, specifically in

handover. SBAR is recommended by the WHO, the Joint Commission, Agency for Healthcare
Research and Quality (AHRQ) and Institute for Health Care Improvement (IHI) as a useful
communication tool during patient handoff. SBAR assists in communicating important
information in an organized and systematic manner which needs immediate notice and action.
Therefore, it contributes to successful escalation of management and improved patient safety.
SBAR has been found to be effective in increasing the handover quality and patient safety. On
reviewing the literature SBAR tool during was found effective for handoff in a range of
departments which include anesthesia (Randmaa, Swenne, Mårtensson, Högberg, & Engström,
2016), perioperative medicine (Merkel & Zwißler, 2017), postoperative medicine (Fabila, et al.,
2016), obstetrics (Scott, 2016), emergency medicine (Ozekcin, Tuite, Willner, & Hravnak,
2015), acute care medicine (Panesar, Albert, Messina, & Parker, 2016), pediatrics (Kotsakis,
Mercer, Mohseni-Bod, Gaiteiro, & Agbeko, 2015), and neonatology (Raymond & Harrison, The
structured communication tool SBAR (Situation, Background, Assessment and
Recommendation) improves communication in neonatology, 2014).
A review was conducted to identify the effect of application of SBAR on patient safety. It
revealed moderate evidence in terms of improvement of patient safety on using SBAR
particularly when it was utilized to organize communication over telephone. But the review has
the limitation of high-quality research which can serve as strong evidence for the effectiveness of
SBAR. The review highlighted that SBAR can be an adaptive means that is appropriate for
various healthcare settings, especially where clear and efficient interpersonal communication is
needed (Müller, et al., 2018). Another study was conducted ascertain the efficiency of
implementing the SBAR tool in an acute clinical facility in South Africa. It was done through
telephone audit which showed a surge in the use of SBAR by registrars from 29% to 70% when
calling consultants for assistance. Most of the staff after receiving training established that SBAR
assisted in communication, confidence, and quality of patient service. Qualitative evidence was
found that SBAR resulted in increased promptness in providing care to the acutely sick
patients. So, the study concluded that by implementing SBAR, communication between
professionals can be improved and enhanced quality and safety of patient can be achieved. The
study recommended the introduction of the tool in other health settings of South Africa
(Raymond, & Harrison, 2014)

It is recorded that poor nurse–physician communication in the various health settings affect the
care of the service users and the work environment adversely for both nurses as well as
physicians. A study was done by utilizing the repeated measures design to evaluate the impact of
SBAR tool and training on communication between nurse and health providers, as nurses and
physicians’ perceptions. 87.5% of the nursing staff who participated in the study rated the tool as
useful in structuring information and offering cues on the content of communication to health
providers. However, nurses also revealed certain limitations of the tool such as time required to
finish the tool, and communication barriers not corrected by the SBAR tool. Physicians also
demonstrated satisfaction over the use of the tool. The study recommended the adoption of
SBAR to deal with the matters of documentation and time limitations (Renz, Boltz, Wagner,
Capezuti, & Lawrence, 2013). Another study focuses on the nurse-physician communication as in
most of the healthcare settings, majority of the communication regarding patient care takes place
between the physicians and nurses. Continuation of the quality care of the patient is also
dependent upon the effective sharing of the patient information from one health care professional
to another during the handoffs. It will reduce the preventable medical errors occurring due to
communication failure. Situational awareness is required during the handoff when the patient
information is exchanged. A narrative review was done to identify the challenges of
communication faced by the health care providers during the routine exchange of patient care
and offers a wider utilization of the SBAR tool for patient handoff in several care facilities. The
challenges identified by the review are the difficulty in using the tool in complicated clinical
scenarios like ICU, need of educational training and change management to learn and sustain the
clinical use of SBAR (Shahid & Thomas, 2018).
A cross-sectional descriptive study was done to investigate nurses’ perception in context of using
SBAR communication tool for patient hand-over at a cancer hospital. Most of the nurses were of
the opinion that SBAR had a logical order which could reduce the communication errors. More
than half of the nurses also stated their interest in always recommending SBAR tool in other
fields. No nurse demonstrated a poor perception about the use of SBAR. It also reduced the mean
duration of handover. Therefore, the study concluded that SBAR is safe and effective tool which
can be recommended for different healthcare facilities as it demonstrated improvement in
communication and patient safety (Nagammal, Nashwan, Nair, & Susmitha, 2017).