🩺 Handover (SBAR)

SBAR is a structured communication framework used to provide a clear, concise, and standardized handover of clinical information. It ensures that critical details regarding a patient's situation, background, assessment, and the required recommendation are communicated effectively between healthcare professionals. By using a predictable format, SBAR minimizes the risk of misinterpretation or the omission of vital data, thereby enhancing patient safety during escalations of care and transitions between clinical teams in the UK healthcare system.

SBAR (Situation, Background, Assessment, Recommendation) is indicated for any clinical communication where pertinent information must be transferred accurately between healthcare professionals. This includes 'escalation of care' when a patient is deteriorating, 'shift handovers' between day and night teams, 'inter-departmental transfers' (e.g., ED to Ward), and 'referrals' to specialist services. It is the gold-standard tool recommended by the NHS to reduce communication errors and improve patient safety during transitions of care.

There are no contraindications to using SBAR, but it should not delay life-saving interventions in a crash or peri-arrest situation where immediate action is required (e.g., 'Cardiac arrest, Room 4' takes precedence over a full SBAR). However, even in emergencies, once the immediate 'call for help' is made, SBAR remains the best tool for the follow-up handover. It should not be used as a substitute for detailed clinical documentation in the patient's medical notes, but rather as a tool for verbal or short-form communication.

Effective SBAR handover requires the patient's medical records, the most recent observation chart (NEWS2 score), and an up-to-date medication administration record (MAR) chart. If communicating via telephone, have a pen and paper ready to record the recipient's name and any instructions given. A 'handover sheet' or structured SBAR template can help organize thoughts before making a call. In many UK trusts, electronic SBAR tools are integrated into the Electronic Patient Record (EPR) for formal shift-to-shift handovers.

Prepare by gathering all clinical data and clarifying your specific goal for the handover. 1. Situation: Identify yourself, the patient, and the immediate concern. 2. Background: State the admission date, primary diagnosis, and pertinent past medical history or recent procedures. 3. Assessment: Provide current clinical findings, including vital signs/NEWS2 and your overall clinical impression (e.g., 'I think they are septic'). 4. Recommendation: State clearly what you need from the other person, the timeframe for action, and any immediate steps you have already taken. Confirm the receiver has understood by using 'read-back' if necessary.

Interpretation of an SBAR handover involves the receiver synthesizing the provided information to prioritize the patient's needs. A high NEWS2 score in the 'Assessment' section must be interpreted as a need for urgent review. The receiver must evaluate the 'Recommendation' against their own clinical judgement—for example, if a junior doctor recommends 'review in the morning' for a tachycardic patient, the senior must interpret this as potentially inappropriate and suggest an immediate review. Effective SBAR closes the loop, ensuring both parties have a shared mental model of the patient's status.

A common error in SBAR is failing to clearly state the 'Recommendation,' leaving the receiver unsure of what action is expected of them. In the 'Situation' phase, some clinicians provide too much irrelevant background, losing the urgency of the message. Conversely, the 'Background' may sometimes be too sparse, omitting critical history like recent surgeries or allergies. Another frequent mistake is not identifying oneself or the patient correctly at the start, leading to confusion or errors in clinical records. Failure to allow the recipient to ask clarifying questions can also lead to miscommunication.

In an OSCE, always start the 'Situation' with 'I am [Name/Role], calling about [Patient Name/DOB] on [Ward]. The reason I am calling is [Urgent Problem/NEWS2 score].' For 'Background,' keep it relevant—focus on why they were admitted and recent changes. In 'Assessment,' give a clear A-E update and include the NEWS2 score. The 'Recommendation' is the most important for marks: be specific about what you want (e.g., 'I would like you to review this patient within the next 30 minutes'). Always finish by asking, 'Do you have any questions or would you like me to repeat anything?'

The SBAR tool was originally developed by the military and adapted for healthcare to improve safety. UK medical students are expected to demonstrate SBAR proficiency in clinical practice and OSCEs, particularly during 'Acute' stations. The 'National Early Warning Score (NEWS2)' is often the centerpiece of the 'Assessment' part of SBAR in the UK. Clear communication is a core competency under the GMC’s 'Good Medical Practice.' Standardizing handover reduces 'infogaps' which are a leading cause of adverse clinical incidents.