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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 (e.g. inpatient, outpatient, urgent, non-urgent, handover) and therefore is a key skill to practise 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 (e.g. 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.
The situation section of SBARR involves a brief couple of sentences that should quickly inform the speaker about the current situation requiring discussion.
Introduce yourself including your name and grade.
Clarify the name and grade of the person you are speaking to.
Provide the basicdetails of the patient you are calling about (e.g. name, gender, date of birth and hospital number).
Provide the patient’s location (e.g. “The patient is located on the haematology ward at the Royal Hospital”) and your own location if different.
Provide the timing of the current problem (e.g. “The patient began to deteriorate 15 minutes ago”)
What and why
Make it veryclear what aspect of the patient’s management you need advice on and explain your current workingdiagnosis if relevant (e.g. “I need your advice on how we should manage the intracerebral haemorrhage.”).
If there have been decisions about the escalation of care and resuscitation, these should also be discussed.
“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 intracerebral haemorrhage, and I’d like you to review the patient.”
The background section of SBARR involves providing an overview of the patient, including the relevant medical details.
Relevant medical details include:
Date of admission
Relevant past medical and surgical history
Relevant medications (e.g. warfarin if the patient has presented with a bleed)
Allergies (particularly if the allergy may impact the choice of treatment)
Relevant investigation results
Current management and the patient’s clinical response
“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.”
The assessment part of SBARR involves communicating your objective clinical assessment of the patient including:
Vital signs: blood pressure, pulse, respiratory rate, SPO2 and temperature.
Clinical examination findings: in the context of an acutely unwell patient an ABCDE approach of reporting your findings can be useful to provide a coherent structure.
Overall clinical impression: this is your working diagnosis (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 48 bpm, 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 increased intracranial pressure as a result of the intracerebral haemorrhage.”
The recommendation section of SBARR includes both your recommendations for what you believe the next most appropriate steps in management should be and also asking what the person on the phone would recommend.
State the following
State your suspecteddiagnosis, what you think needs to happen and in what time frame you expect those things to happen.
“This lady has suffered an acute intracerebral haemorrhage and given the ongoing clinical deterioration she needs urgent review by the neurosurgical team.”
Ask the following
Whether they can review the patient and in what time frame they would be able to do this.
Whether there is anything further you could do (e.g. requesting investigations, administering treatments).
Whether a transfer to anotherclinicalenvironment is required (e.g. ward, theatre, ICU).
“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?”
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 and review
This final part of SBARR 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.
Things you should do
Check that they have accuratelyunderstood the current clinical situation and check if they have any furtherquestions.
Clarify expectation of response (e.g. “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).