SBAR

SBAR
Name	SBAR
Type	Communication framework

SBAR SBAR is a structured communication framework used to convey concise information in healthcare, emergency response, and organizational settings. It originated from standardized protocols in United States Navy and was adapted by clinical institutions such as The Joint Commission, World Health Organization, and major academic centers including Johns Hopkins Hospital and Mayo Clinic. The model is applied in settings involving actors like Registered nurse, Physician, Pharmacist, Respiratory therapist, and agencies such as National Health Service and Centers for Disease Control and Prevention.

Background and origins

SBAR was adapted from naval and aviation checklists evolving in contexts like the United States Navy and Boeing cockpit procedures, influenced by safety work from figures and institutions including Florence Nightingale's sanitation reforms and the systems engineering principles used by W. Edwards Deming and James Reason. It entered clinical practice through initiatives by organizations such as Institute for Healthcare Improvement, Joint Commission Resources, and research teams at University of Pennsylvania, Harvard Medical School, and University of Michigan. SBAR’s propagation involved collaborations among American Nurses Association, American Medical Association, and healthcare systems like Kaiser Permanente and Veterans Health Administration.

Structure and components

The framework comprises discrete components commonly taught as Situation, Background, Assessment, Recommendation. These map onto practical tasks performed by professions including Nurse practitioner, Intensive care unit physician, Emergency physician, and Critical care nurse. Implementation draws on communication standards promoted by bodies like Occupational Safety and Health Administration and curriculum models used by Harvard School of Public Health and University of California, San Francisco. Variants align with reporting templates from World Health Organization patient safety programs and handover tools from Royal College of Nursing.

Applications in healthcare

SBAR is used across acute care environments such as Intensive Care Unit, Emergency department, Operating theatre, and ambulatory settings affiliated with institutions like Cleveland Clinic and Mount Sinai Health System. It supports transitions involving Registered nurse to Physician assistant handoffs, consults to specialists like Cardiologist and Pulmonologist, and interprofessional rounds including Pharmacist medication reconciliation. Health systems incorporate SBAR into electronic health record workflows from vendors such as Epic Systems and Cerner Corporation to standardize communication during events analyzed by responders like Emergency Medical Technician.

Training and implementation

Training programs for SBAR have been integrated into curricula at institutions such as Johns Hopkins University School of Nursing, University of Pennsylvania School of Nursing, Columbia University Irving Medical Center, and professional development through American Nurses Association modules. Techniques include simulation-based education using scenarios developed by Society for Simulation in Healthcare, role-play sessions inspired by TeamSTEPPS materials from Agency for Healthcare Research and Quality, and e-learning platforms from providers like Coursera and LinkedIn Learning. Implementation strategies often involve change management frameworks described by Kotter International and quality improvement cycles from Institute for Healthcare Improvement.

Effectiveness and evidence

Evidence for SBAR’s impact appears in systematic reviews and trials from journals affiliated with publishers such as Elsevier, Springer Nature, and Wolters Kluwer Health. Studies at sites including Brigham and Women's Hospital, Vanderbilt University Medical Center, and University of Toronto report improvements in clarity of handoffs, incident reporting rates, and team situational awareness measured using instruments from Agency for Healthcare Research and Quality. Large-scale initiatives evaluated by organizations like The Joint Commission and National Health Service show mixed but generally positive effects on communication-related adverse events, with outcome measures drawn from databases maintained by Centers for Medicare & Medicaid Services.

Limitations and criticisms

Critics from academic centers such as McMaster University, University of Oxford, and commentators in outlets like The Lancet and BMJ note limitations including variability in adherence, overreliance on templates, and reductionism that may omit complex clinical nuance. Implementation barriers cited by institutions like World Health Organization and National Institute for Health and Care Excellence include cultural resistance among professions like Consultant (medicine) and logistical constraints in settings such as Rural health clinic. Methodological critiques point to heterogeneity in study designs and outcomes reported in reviews produced by groups like Cochrane Collaboration.

Category:Medical communication