What is the ISBAR (Identify, Situation, Background, Assessment, Recommendation) handover protocol?

ISBAR Handover Protocol

ISBAR (Identify/Introduction, Situation, Background, Assessment, Recommendation) is a World Health Organization-endorsed structured communication framework that standardizes clinical handover to reduce errors, improve patient safety, and ensure continuity of care across all healthcare settings. 1, 2

What ISBAR Stands For

The five components of ISBAR provide a systematic approach to information transfer: 2, 3

• I - Identify/Introduction: State your name, role, location, and the patient's name and identifiers 2, 4
• S - Situation: Briefly describe the current clinical concern or reason for communication 1, 2
• B - Background: Provide relevant patient history, medications, allergies, and contextual information 1, 2
• A - Assessment: Present your clinical assessment including vital signs, findings, and professional judgment about what is occurring 1, 2
• R - Recommendation: State specific recommendations or what you need from the receiving clinician 1, 2

Why ISBAR Improves Patient Safety

Structured communication frameworks like ISBAR reduce adverse events by 40% in emergency settings and decrease unplanned ICU admissions through improved information transfer. 1

Key benefits include: 2, 3, 4

• Ensures critical information is not omitted during handover 2
• Reduces medical errors through standardized communication 1
• Improves interprofessional communication skills and confidence 3
• Increases predictability and security for healthcare teams 4
• Enhances patient involvement in care transitions 5

Implementation Requirements

Both verbal face-to-face handover AND complete written documentation are required—neither alone is sufficient. 6

Essential implementation elements: 7, 2

• All team members must be trained in the same framework for maximum effectiveness 2
• Handover should occur at the bedside whenever possible to identify risk events directly (occurs in 8.3% of bedside handovers) 5
• Use closed-loop communication where the receiver repeats back key information to confirm understanding 1
• Document all ISBAR elements in the medical record 6
• Establish clear protocols for interhospital transfers using ISBAR structure 7

Clinical Applications

ISBAR is suited to multiple clinical contexts: 2, 3, 4

• Shift handovers: Nurses report 87% of handovers successfully occur at bedside using ISBAR 5
• Emergency department transfers: Improves communication reliability and patient care 5
• Critical care settings: Increases situational awareness between nurses and physicians 4
• Major hemorrhage protocols: Recommended for structured communication between clinical and laboratory areas 7
• Stroke systems of care: Essential for safe patient transfers within and between facilities 7

Common Pitfalls to Avoid

Do not rely solely on written handover without verbal communication—this increases risk of information loss; conversely, verbal-only handovers lead to omissions. 6

Additional pitfalls: 2, 4, 5

• Including irrelevant detail while omitting critical information 2
• Failing to tailor ISBAR use to each specific clinical situation 4
• Not ensuring all team members (including physicians) are engaged with the framework 4
• Inadequate staffing that makes thorough handover time-prohibitive 5
• Lack of organizational investment in training and education 2

Training and Sustainability

Organizations must invest in education and training across all health disciplines to ensure ISBAR is embedded effectively in practice. 2

Training recommendations: 2, 3, 4

• Use simulation exercises and resource lectures with intervals for practice integration 4
• Conduct debriefing sessions to discuss communication effectiveness 8
• Audit handover processes regularly to assess adherence and outcomes 5
• Integrate electronic patient records (EPR) to further increase handover efficacy 3
• Establish a culture of mutual respect and psychological safety where team members feel comfortable using structured communication 1