SBARR (Situation, Background, Assessment, Recommendations, Review/Response) was designed as a structured method for communicating critical information that requires immediate action and advice. However, it is useful in all sorts of settings (inpatient, outpatient, urgent, non-urgent, handover) and is, therefore, a key skill to practice as a medical student.
Key points when using SBARR
1. Ensure that you have all the information in front of you before making the phone-call (patient’s notes, investigation results, observation charts). If everything is electronic make sure you’re logged in with the data opened in front of you.
2. Stay calm even if the person on the other end of the phone is distracted or unhelpful. Being polite will get you much further, and a ‘Thank you’ at the end of the conversation is always appreciated.
3. Don’t feel worried about asking a colleague for advice, remember you are doing so to ensure high-quality patient care. If you find yourself in the unlikely scenario where someone will not help you, document this along with their name, bleep and what time you tried to contact them. You can then seek advice from other senior members of your team.
4. The breadth and depth of information you communicate should change depending on the situation. You should choose the points from each section that are relevant to your given scenario.
This is a brief couple of sentences that should orientate yourself and the speaker to the current situation requiring discussion.
- Introduce yourself (name and grade)
- Ask whom you are speaking to (their name and grade)
- Identify the patient you are calling about (their name, gender, age, date of birth and hospital number)
- The patient’s location
- Your location (if different)
- Timing of the current problem
What and Why
- What you need advice about and your working diagnosis
- This is the selling line, why should the person on the other end of the phone pay attention?
‘Hello, I’m David, an FY1 calling from the A&E. Can I ask who I’m speaking to? …”
“I’m calling about a patient called Jane Doe (DOB, NHS number), a 62-year-old lady who arrived 15 minutes ago with a suspected stroke, and I’d like you to review the patient.”
If there have been decisions about escalation of care and resuscitation, these should also be mentioned.
This is the part where you need to give your colleague an overview of the patient, including the relevant medical details.
These may include:
- Admission reason (presenting complaint)
- Date of admission
- Current diagnosis
- Patient’s relevant past medical and surgical history
- Relevant medications (e.g. Warfarin if the patient has presented with a bleed)
- Allergies (particularly if the allergy is to a treatment that may be considered for their presenting complaint)
- Investigation results
- Any interventions tried, and the patient’s clinical response to them
“Mrs Doe presented with acute onset dysarthria, left-sided limb weakness and inattention. Her past medical history includes a TIA in August 2017, hypercholesterolaemia and atrial fibrillation. She is anticoagulated with warfarin and her admission INR is 4.8. A CT head demonstrates an intracerebral haemorrhage in the right hemisphere with some associated mass effect and midline shift. We are currently administering Beriplex but the patient does appear to be becoming more drowsy.”
This section involves communicating your objective clinical assessment of the patient including:
- Vital signs – Blood pressure / Pulse / Respiratory rate / O2 saturations / Temperature
- Clinical examination findings (in the acutely ill patient adopting an ABCDE approach to reporting your findings can be useful to provide a coherent structure)
- Overall clinical impression – (e.g. “the patient appears septic” “the patient is neurologically deteriorating“)
“The patient currently has a NEWS score of 7 due to being bradycardic at 48bpm, hypertensive with a BP of 222/110 and only responsive to pain. Respiratory rate and oxygen saturations are currently within normal limits.”
“On assessment, her airway is not currently compromised, there is bilateral air entry on the chest with no added sounds. Her pulse is irregular, with a rate of 48 beats per minute. Neurological examination reveals dense left-sided weakness and a GCS of 11 which has fallen from her arrival GCS of 14. Capillary blood glucose is 7. There is no external evidence of head injury and there is no visible rash.”
“The patient appears to be neurologically deteriorating, most likely secondary to increasing intracranial pressure as a result of the intracerebral haemorrhage”.
This includes both your recommendations for what you think needs doing for the patient and also asking what their recommendations are for further management.
- The suspected diagnosis
- What you think needs to happen and in what time frame
“This lady has suffered an acute intracerebral haemorrhage and given the ongoing clinical deterioration she needs urgent review by the neurosurgical team.”
- Whether they can review the patient and in what time frame
- Whether there is anything further you could do (requesting investigations, administering treatments)
- Whether transfer to another ward is required
“Are you able to come and review the patient now? In the meantime is there any other treatments or investigations you’d suggest? Are you happy to accept this patient for transfer urgently to the neurosurgical high dependency unit?”
What if you’re not sure what’s happening?
If you’re unsure of the diagnosis or management, you can say something like: “I am not sure what the problem is, but the patient is deteriorating” and then state how they are deteriorating. Or even, “I’m not sure what the problem is, but I’m really concerned and would appreciate your input”.
RESPONSE / REVIEW
This is important as it ensures that the respondent has understood everything you have said, allows them to ask any further questions and allows you to clarify the expected response.
- Check that they have accurately understood the current clinical situation and check if they have any further questions
- Clarify expectation of response “So you’ll be coming within the next 5 minutes to review the patient?“
- Document the discussion in the patient’s notes, including the details of those involved in the discussion (name, grade, bleep, their advice and timings)
- Thank the person at the end of the conversation