Patient Handoff Tutorial--SBAR

Learn how "SBAR" works as a communication tool...

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The patient is admitted to the ICU and, after your initial evaluation and orders, you go to see another patient. 90 minutes later, your patient's nurse calls and tells you that your patient is having more difficulty breathing. When you see the patient, she is more tachypneic (RR 50) and is trying to sit up. She is complaining that her chest hurts "all over." HR 144, BP 100/75, T100.8, SpO2 88% on non-rebreather O2 mask. She has JVD, bilateral crackles about 2/3 up her posterior lung fields, 1+ edema. You cannot hear an S3 or murmur because of her fast heart rate. The nursing flowsheet indicates that she has received broad-antibiotics for community-acquired pneumonia and about 3700 mL of IV fluid since admission to the ED. You order a CXR and an arterial blood gas.

1. Be an SBAR reporter and develop your own SBAR "Handoff" in the box below. Imagine that you are the intern and you are updating your attending (SBAR receiver), who already knows about the patient's initial presentation.

SBAR

Show/Hide our suggested SBAR Elements

Here is what we thought might be an appropriate SBAR...

S (Situation): I want to update you about Ms. Smith in 5W ICU Bed #8. She has become much more dyspneic, although her hypotension is a little better.

B (Background): She's the patient we thought had community-acquired pneumonia leading to probable septic shock. In addition, she has well-controlled SLE, is on minimal immunosuppression, and has a history of antiphospholipid syndrome.

A (Assessment): I'm worried about fluid overload/pulmonary edema because she has gotten 3.7 L of fluid, has bilateral crackles, JVD, and peripheral edema. The other possibilities are ARDS from sepsis/worsening pneumonia. CXR and ABG are ordered.

R (Recommendation): I'm planning to stop the IV fluids, review the CXR, and continue antibiotics. What do you think of the possibility of pulmonary embolism? Also, should we consider cardiac ischemia?

Alternative Recommendation? I don't know what else to do and I'm concerned that we're missing something--please meet me in the ICU to review the patient.

2. What are some of the features of SBAR?

A. May work best for a single acute event.

B. Requires an assessment by the SBAR reporter.

C. Leaves decision-making solely to the SBAR receiver.

D. Includes information about drug allergies.

E. Anticipates later problems.

Show/Hide the Answer and Discussion for Question 2

A and B are most correct.

SBAR works best for acute, single events, such as change in a patient's status, rather than a whole system of patient handoffs.

The SBAR reporter should make an assessment of the patient's likely current problem, within reason, because this helps the SBAR receiver to understand urgency, potential issues, and how much the recommendation will mean.

Decision-making may involve both the SBAR receiver and reporter because often the reporter has more first-hand information and may have tried some interventions already. Drug allergies may be important, as are family/social history, but need not be reported if not relevant. If the SBAR receiver has some different ideas, then these data may have to be obtained.

SBAR usually does not assess or evaluation "future" problems because it most often reflects the current single issue at hand.