SBAR Communication Framework
The communication described is the "Recommendation" component of the SBAR (Situation, Background, Assessment, Recommendation) framework, which is a structured communication tool designed to improve patient safety and ensure critical information is conveyed systematically between healthcare providers. 1, 2
Understanding the SBAR Framework
The SBAR tool consists of four sequential components that structure clinical communication 2, 3:
- Situation: The current clinical issue requiring immediate attention (e.g., "I'm calling about a patient in the ICU with respiratory distress") 2, 4
- Background: Pertinent patient history, diagnosis, medications, and relevant clinical context 2, 4
- Assessment: The provider's clinical evaluation and interpretation of the patient's condition 2, 4
- Recommendation: Specific suggestions for action, including requests for the receiving provider to evaluate the patient 2, 4
Why SBAR Matters in Critical Care
SBAR implementation has been shown to improve patient safety outcomes, particularly when structuring telephone communications between nurses and physicians in the ICU setting. 5
The evidence demonstrates:
- Communication quality: SBAR use by ICU registrars calling consultants increased from 29% to 70% after training, with staff reporting improved confidence and quality of patient care 3
- Patient safety: A systematic review found moderate evidence for improved patient safety through SBAR implementation, with 8 of 26 measured patient outcomes showing significant improvement 5
- Reduced adverse events: Structured communication tools like SBAR address communication breakdown, which is one of the main causes of adverse events in clinical routine 5
Common Pitfalls in SBAR Use
Real-world implementation reveals specific weaknesses 2:
- Background component: Only 17% quality score in actual ICU practice, indicating providers often omit critical patient history 2
- Assessment component: Only 17% quality score, showing inadequate clinical interpretation is commonly communicated 2
- Recommendation component: Only 33% quality score, demonstrating providers frequently fail to provide clear action requests 2
- Overall quality: Median SBAR quality score in ICU practice was only 41%, despite widespread adoption 2
Improving SBAR Effectiveness
Pre-graduate mandatory training combined with repeated practice significantly improves SBAR quality, with trained nurses scoring 11.53% higher than untrained counterparts. 2
Key implementation strategies include 3, 4:
- Regular training sessions emphasizing all four components, not just "Situation" 2, 4
- Focus on developing clinical assessment and judgment skills, which are the weakest components 2
- Integration with broader communication frameworks recommended by major guidelines (SPIKES, PREPARED, VALUE mnemonic) 1
- Combining SBAR with structured family conferences and interdisciplinary communication protocols in ICU settings 1
Integration with Broader Communication Guidelines
SBAR should be embedded within organized communication frameworks that guide bidirectional communication about patient care, particularly in ICU and end-of-life settings. 1
The American Society of Clinical Oncology and European Society of Intensive Care Medicine both recommend 1:
- Using structured frameworks (including SBAR) to guide clinical communication 1
- Implementing structured training programs for ICU healthcare professionals to enhance communication competencies 1
- Combining verbal SBAR communication with written tools (brochures, pamphlets) to improve family comprehension and reduce psychological distress 1