SBAR For Leadership Communication In Healthcare And Other Industries

By Kelly L. Podgorny04cf612dc31320fa6316bcef3158c7bb-huge-ke
Originally published in the Spring 2020 Quality Management Forum

Introduction

The concept of SBAR (Situation, Background, Assessment, Recommendation) is a communication tool that was introduced by the American military in the 1940s. It was later targeted specifically for nuclear submarines where concise and relevant information was essential for safety. Since then, the SBAR communication tool has been used in a variety of industries, including healthcare.

The Basic SBAR Communication Tool in Healthcare

SBAR is simple in concept. The purpose is to provide essential, concise information, usually during crucial situations. It can be used between professional staff such as nurses and physicians. It also has value for handoffs by nurses between change of shifts or patient transfers.

SBAR can be written or provided verbally. Below is a description of each component of the SBAR with a written healthcare example. Table 1 below presents a patient focused SBAR. Tables 2 and 3 on a subsequent page are focused on leadership communication. The examples below are healthcare-related, but you can think about how SBAR could be used as a leadership communication tool in your industry.

Situation

In this initial section, the exact circumstances of the situation get explained. Non- essential information is excluded. The focus should be on the seriousness of the situation.

EXAMPLE: The patient has been hospitalized with an upper respiratory infection. Respirations are labored and have increased to 28 breaths per minute within the past 30 minutes. Usual interventions are ineffective.

Background

Table 1 - Health Care SBAR Patient Focus
1. Situation The patient has been hospitalized with an upper respiratory infection. Respirations are labored and have increased to 28 breaths per minute.
2. Background The patient is a 72-year-old female with a history of CHF and COPD. Her husband has requested to be notified if the patient’s condition changes.
3. Assessment Patient’s breathing has deteriorated in the last 30 minutes. Usual
interventions (inhaler, oxygen, breathing treatments) have been ineffective and are not relieving symptoms.
4. Recommendation Consider intubation immediately. Call the Rapid Response Team and other providers as needed.
The background section presents essential information related to the situation. This information should pertain to the current situation. For instance, the patient’s past illnesses, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), are highly relevant to the current situation, but the patient’s home address is not relevant at this time. 

EXAMPLE: The patient is a 72-year-old female with a history of CHF and COPD. Her husband has requested to be notified if the patient’s condition changes.

Assessment

The assessment must be made by a qualified staff person (such as a registered nurse) caring for the patient. It is a precise statement about the patient’s condition based on the situation and background information. The assessment is not a diagnosis unless it is made by a provider such as a Doctor of Osteopathy (DO), Medical Doctor (MD), Physician Assistant (PA), or an Advanced Practice Registered Nurse (APRN).

EXAMPLE: Patient’s breathing has deteriorated in the last 30 minutes. Usual interventions (inhaler, oxygen, breathing treatments) have been ineffective and are not relieving symptoms.

Recommendations

The qualified staff member makes a recommendation for resolving the situation to the provider based on the situation, background, and assessment.

EXAMPLE: Consider intubation immediately. Call physician STAT or initiate Rapid Response Team.

Table 1 demonstrates how this patient focused SBAR would be displayed in an actual situation.
 

Applicability of SBAR as a Leadership Communication Tool

The SBAR communication tool has demonstrated its versatility in several industries, and its ability to improve safety is well documented. The tool has also demonstrated its ability to improve communication and decrease patient harm in healthcare settings. In some cases, SBAR can replace an executive summary in a
formal report because it provides focused and concise information. Leadership and administrative areas where an SBAR can assist with clear communication include:
Table 2 Community Services
1. Situation Community X has a population that includes many residents with mental health needs. However, mental health care is fragmented and not tied to primary care or to the community hospital.
2. Background Community X is a rural community with one critical access hospital (CAH) that does not provide mental health services. Patients with mental health issues are seen in the emergency department, which is ineffective and costly. There are no systematic referral systems among the hospital, primary care physicians, and mental health practitioners.
3. Assessment A collaborative care model among the hospital, primary care, and mental health practitioners needs to be developed to provide patients with better mental health care.
4. Recommendation Hospital leadership needs to seek out mental health practitioners in the community for discussion. Additionally, leadership should consult with the American Psychiatric Association to review the applicability of their collaborative care model to Community X.
  • Finance
  • Community services
  • Human resources
  • Environmental services
  • Quality improvement
  • Automotive industries
  • Aviation industry
  • Manufacturing
  • Governmental agencies
Table 2 is an example of an SBAR Communication to hospital leadership written by a primary care physician.
Table 3 provides an example of a quality improvement SBAR to leadership in a healthcare organization.
 
Table 3 Quality Improvement
1. Situation In a drug dependency rehabilitation center, patients are experiencing extreme dental pain not relieved with over-the-counter medications.
2. Background Many of the patients in this drug rehabilitation facility have long-standing use of heroin and other narcotics since late childhood. Additionally, numerous patients have not received ongoing dental care. Dental exams indicate several caries and abscesses within this population. Therefore, when patients are withdrawn from an opioid, they experience extreme pain that is not relieved by over-the-counter pain relievers.
3. Assessment Medical and dental staff need to provide relief medications that will relieve the pain. These patients also require dental intervention as soon as possible.
4. Recommendation 1. Dental and medical staff need to consult with state and national organizations to determine medications that should be used for this dental pain, as well as alternative treatments.
2. Patients need to be prioritized for dental intervention ASAP.

Summary

The purpose of this article has been to introduce you to the use of the SBAR communication tool for issues related to leadership. This adaptable tool, which started out in the American military, has been used in multiple industries, including healthcare. Healthcare has broadened its use by developing leadership SBARs. Leadership SBARs are used to provide information about non-clinical as well as clinical issues. The SBAR tool is likely to be accepted by leadership because the format clearly provides important information that allows leaders to prioritize issues as well as the resolution of those issues.

Bibliography

Achrekar, M., Murthy, V., et al. “Introduction of situation, background, assessment, recommendation into nursing practice: A prospective study.” Asia Pacific Journal of Oncological Nursing. Jan.–Mar. 2016, pp. 45–50.

Jurns, C. “Using SBAR to communicate with policymakers.” OJIN: The Online Journal of Issues in Nursing. 2019, p.13.

NHS Improvement ACT Academy Online library of Quality, Service Improvement, and Redesign Tools. “SBAR Communication Tool – situation, background, assessment, recommendation.” improvement.nhs.uk/documents/2162/sbar -communication-tool.pdf.
 

About the author 

Kelly L. Podgorny DNP, MS, CPHQ, RN is an accomplished nurse executive. She is a nationally recognized project director in quality, outcome improvement, policy development and implementation, high reliability, patient safety, project management, medication management, and infection prevention. After working at The Joint Commission (TJC) for several years, she is highly skilled at developing clinically focused standards and survey process. She can be reached at kpod59@outlook.com.
Posted by Jerry Rice on Jul 1, 2020 2:40 PM America/Chicago

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