Background
Handovers and SBAR
A patient handover involves transferring care responsibilities for a patient, either temporarily, or permanently, to another individual. Communication errors are a significant cause of adverse events, often due to missing patient information or a lack of structure in presenting them.
The Situation, Background, Assessment, and Recommendation (SBAR) acronym is widely used in healthcare to convey patient information effectively and concisely. It offers a structured way to communicate between healthcare professionals and is also helpful in urgent situations or scenarios with hierarchical differences.
OSCE Tips and Scenarios
OSCE Scenarios
In SBAR OSCE stations, candidates are given patient information (e.g. their history, examination findings, test results, and management steps) and must convey it succinctly and safely, also making a request or recommendation. These stations assess the ability to identify relevant information, interpret data, evaluate patient stability, and suggest appropriate actions. Additionally, clear communication skills are crucial.
Mistakes that people make
Getting an SBAR right is difficult and needs a lot of practice. Listing a large stream of information appears disorganised, but also increases the risk of key parts being missed and possible adverse outcomes. Mistakes that are often made include:
- Handing over in a disorganised/unstructured manner
- Being unable to differentiate between relevant and irrelevant information
- Being unsure of what to request from the recipient or being unclear about this
Tips for the station
Get their attention early: highlight important information to grab their attention and avoid listing everything. For example, in someone with suspected appendicitis, you could say “I’m calling about a 20-year-old man with acute severe right iliac fossa pain, concerned about possible appendicitis”. This gets the recipient’s attention and conveys that urgent care is needed. Sometimes thinking as if you are ‘convincing’ the person can help with structuring the SBAR. Remember to be truthful and never falsify any information.
Avoid lengthy lists and group: group information and give an overall impression before listing things out. This shows that you are actually processing and interpreting the information rather than regurgitating it. For example, instead of listing out a past medical history of hypertension, type 2 diabetes, and hypercholesterolaemia”, you could say “They have multiple cardiovascular risk factors, including hypertension, type 2 diabetes, and hypercholesterolaemia”. The same goes for parts of the assessment, such as “This patient is febrile and haemodynamically unstable, with a blood pressure of 90/45 mmHg, a pulse of 120 bpm, and a temperature of 38.3°C”.
Clarify requests and know what you want: be clear when asking for support, even if you are unsure. The R part of the SBAR can feel intimidating, especially when requesting something from a senior, but it is okay to admit uncertainty and ask for help. For example, “Can you advise on what to do for this patient with a drug rash and stable vital signs?”. The worst that could happen is that the recipient may advise you to try something else first, such as contacting another individual or arranging some tests.
Approach
Preparation
Thoroughly prepare your SBAR handover. This is important to make sure you convey all the right information and prepare you for any questions the recipient may ask. Work through the information chronologically, including their history, current medications, allergies, tests, treatment, vital signs, and examination findings. The recipient may not know the patient as well as you do, so it is important to ensure they have all the necessary information to understand the current situation.
Introduction
Introduce yourself and check this is the right person. Make sure to check their full name, role, and location, along with stating yours. You should explain why you are calling to avoid any miscommunication:
- Introduce yourself: with your full name, role, and location.
- Confirm who you are speaking to: including their full name, role, and location.
- State what you think the current problem is: “I’m worried about this patient who may have sepsis secondary to a urinary tract infection”.
- Explain why you are calling: “I’m worried about this patient becoming more unwell and I need some help”.
Situation
Briefly describe what’s going on. This part of the SBAR should describe the current situation, patient details, and reason for handover concisely to capture the recipient’s attention. Stating this information also allows the recipient to look up the patient details while receiving the handover:
- Provide patient information: their name, date of birth, sex, NHS number, and location (e.g. what ward they are on). This is important as some people can have the same names and dates of birth. Providing all of this information reduces the risk of getting people mixed up.
- State the current problem and timeline: explain what is going on and over what timeframe, e.g. “This patient was brought via ambulance 1 hour ago and has since had IV antibiotics and fluids but has deteriorated in the last 10 minutes”.
- Explain the reason for the handover: tell the recipient what you think about the current situation and the stability of the patient, e.g. “They seem very unwell. I’d like to see if you could review them and help”.
Background
Provide context and briefly explain the story. This part provides context about the patient’s admission. You should provide information relevant to their admission, such as information that would likely affect the patient’s management. For example, a past medical history of appendicitis at 14 years of age is unlikely to be useful in a 60-year-old man with acute coronary syndrome. Things to bear in mind are possible issues that could arise, such as drug interactions, renal/hepatic impairment, frailty, and possible surgical complications:
- Current problem history: provide relevant components about the events leading up to now. For example, how long it has been, how they got here (e.g. via ambulance), and a summary of what has happened since (e.g. treatment given, tests taken etc.).
- Past medical history: provide relevant components about the patient’s past medical history, and where possible, try to group them. For example, “This patient has multiple cardiovascular risk factors, including hypertension, type 2 diabetes, and hypercholesterolaemia”.
- Past surgical history: relevant for perioperative scenarios.
- Drug history and allergies: where possible, try to group them. For example, “This patient is on multiple antihypertensives including ramipril, amlodipine, and indapamide. They also take antidiabetic medications, including metformin and sitagliptin”.
- Relevant social history: provide information that is likely to change the patient’s assessment and management. For example, an elderly person presenting with a fall who lives alone, has visual impairments, and is struggling with their activities of daily living.
Assessment
Explain what you think is happening and justify it with important findings. Convey the patient’s stability, working diagnosis, and the best next steps, justifying them based on assessment findings, test results, and treatments given and the patient’s response. Try to group each statement and give an overall impression before listing them out. Using a mini-ABCDE approach may help:
- Overall impression and stability: make an overall impression of their stability first, for example, “They look very unwell and have become cyanosed with mottled skin”.
- Observations/vital signs: share the NEWS score, pulse, respiratory rate, blood pressure, oxygen saturation, temperature, and Glasgow coma/ACVPU score. For example “This patient is haemodynamically unstable and afebrile, with a pulse of 115 bpm, a respiratory rate of 23 /min, a blood pressure of 90/45 mmHg, an oxygen saturation of 92% on room air, a temperature of 38.3°C, and they are currently confused”.
- Airways: are their airways patent?
- Breathing: any respiratory examination findings or test results?
- Circulation: any cardiovascular examination findings or test results?
- Disability and neurology: any examination findings or test results? Never forget glucose.
- Exposure, everything else, and abdomen: any examination findings or test results?
- Postoperative status: any relevant findings? Such as the appearance and status of any wounds, drains, lines etc.
- Relevant tests: discuss relevant tests that have been performed, their results, and what is being awaited. Where possible, try to group them, e.g. “initial blood tests including full blood count, urea and electrolytes, and CRP have shown high white cell counts, increasing creatinine, and high CRP. An arterial blood gas is being performed and blood cultures haven’t returned yet”.
- Relevant treatment: discuss what has been done so far and what is likely to happen. Again, try to group things where possible.
- Problems needing addressing: what else needs doing?
- Working diagnosis/current problem: state what you think is going on, e.g. “I’m worried about this patient going into septic shock”.
Recommendation
Clearly state needed actions and their timeframes and ensure understanding and agreement. Precisely describe what you need from the recipient and its timeframe. If you don’t know what’s going on, request for help. The recipient must know exactly what you want, when you want it, and who is responsible for the next steps:
- Make a recommendation/request: such as further tests, specific treatment, a review to consider a return to theatre etc. e.g. “they’re unresponsive to treatment and getting worse, I need some help. Please could you come and see this patient?”
- If you are unsure about what’s going on, tell them and ask them for help. For example, “I’m not sure what’s going on with this patient as they have had a drug rash and are haemodynamically stable. Would it be possible for you to see the patient and advise on what to do next?”
- State the urgency and timeframe: be specific and state a clear timeframe. For example, “Can you come and see this patient within the next 10 minutes?”.
Finishing
Confirm their understanding and clarify expectations. Invite the recipient to ask further questions and clarify expectations. This lets you ensure they know what is going on and what will happen next:
- Check understanding: is there anything they would like to clarify?
- Invite them to ask questions: is there anything else they’d like to ask?
- Say what you’ll do in the meantime/ask for suggestions: is there anything that can be done in the meantime? (e.g. arranging further tests, starting/stopping treatment etc.).
- Summarise and clarify expectations: confirm that the handover has been made and that they will carry out your request in the timeframe suggested. For example, “Just to summarise, you are happy to see this patient in the next 10 minutes and you would like me to start some maintenance IV fluids. Is that correct?”
- Provide them with contact details: encourage them to get in touch if needed
- Thank them for their time: remember that the recipient is a human being and be polite.
