implementing EBP
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Kathryn R. Stewart, BSN, RN, is Registered Nurse, Shock and Trauma ICU, Erlanger Health System, Chattanooga, TN. Kelli A. Hand, DNP, MBA, RN, is Lecturer, School of Nursing, University of Tennessee, Chattanooga, TN.
SBAR, Communication, and Patient Safety: An Integrated Literature
Review
I n the landmark Institute of Medicine report To Err is Human, editors Kohn, Corri -
gan, and Donaldson (2000) brought attention to the epidemic of med- ical errors occurring in the U.S. healthcare system. They concluded the root cause of these errors often could be traced to faulty systemic processes. Errors in communication have been a major source of miscal- culation and misdirection in health care. According to The Joint Com - mission (2015), communication errors have been among the top three leading root causes of report- ed sentinel events every year since 2004. Times of patient handoff may contribute to informational gaps due to the frequency with which these reports occur and the high- stakes nature of the information being exchanged (Staggers & Blaz, 2013).
Objective The objective of this systematic
review is to analyze literature addressing use of the Situation- Back ground-Assessment-Recom - mendation (SBAR) framework to determine its effectiveness during patient handoff communication between healthcare pro viders. The review approach allowed inclusion of multiple variables and diverse methodologies, making it the most suitable method available for ana- lyzing the literature pertaining to SBAR’s impact on communication and patient safety (Torraco, 2016).
Background The Joint Commission (2008)
initially defined handoff as “the real- time process of passing patient-spe- cific information from one caregiv- er to another, or from one team of caregivers to another for the pur- pose of ensuring the continuity and safety of a patient’s care” (p. 65). Despite their purpose of providing necessary information for delivery of safe patient care, patient hand- offs appear to be prone to errors related to frequent communication barriers (Mardis et al., 2016). Common barriers to effective hand- off communication include the hierarchical nature of health care, organizational culture, differences in the practiced communication style of healthcare professions, lack of a standardized process, and an increasingly complex care environ- ment (Daniel & Wilfong, 2014; The Joint Commission, 2005, 2012). In addition, the varying parties and the large amount of complex infor- mation included in handoff reports
frequently contribute to informa- tional gaps and omissions in the handoff report that can lead to sen- tinel events and patient harm (Staggers & Blaz, 2013).
To reduce communication errors during handoff, SBAR was created by U.S. Navy personnel as a method for conveying critical information in an effective, timely, and succinct way (Curry-Narayan, 2013). Em - ployed primarily in high-risk situa- tions of the Navy’s nuclear subma- rine industry, the SBAR communi- cation tool enabled all users, regard- less of the level of command, to communicate via a common struc- ture. Clinical staff at a Kaiser Perma - nente organization in Colo rado adapted the SBAR communication template for use in health care (Institute for Healthcare Improve - ment, 2016). Following initial use between nurses and physicians, the SBAR template also has been used to guide handoffs in the nurse-to- nurse shift change report and inter- professional patient reviews (Raiten et al., 2015; Vardaman et al., 2012).
Kathryn R. Stewart Kelli A. Hand
The SBAR (Situation-Background-Assessment-Recommendation) tool was introduced to health care in 2002 to guide communica- tion of patient care information. Evidence of an integrated literature review indicates SBAR is an effective intervention for patient safety through improved communication.
Instructions for Continuing Nursing Education Contact Hours appear on page 304.
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Introduction of the SBAR tool has brought regularity and predictabili- ty to handoff communications and has been endorsed by The Joint Commission (2012).
Methods The combined search terms of
SBAR, communication, and patient safety were entered into PubMed, CINAHL Complete, and Cochrane Library databases to find peer- reviewed, English-language articles
published 2012-2017 that evaluated the effect of SBAR use on patient safety and communication between healthcare providers. Additional exclusion criteria included overlap- ping articles between databases, studies still in progress with no avail- able results, articles describing only the implementation process of SBAR, articles assessing SBAR use between non-healthcare profession- als, and editorials. After application of the exclusion criteria, 21 articles were retained for this review. The
included publications were analyzed for findings about SBAR use, com- munication, and patient safety.
Results Results of the empirical studies
were entered in a table to identify recurring themes regarding SBAR use and the effect on communica- tion and patient safety (see Table 1). Four primary themes were identi- fied.
TABLE 1. Studies and Themes
Author/Date Methods Results Setting/Sample LOE Blom et al., 2015
Pre/post-SBAR questionnaire to evaluate healthcare professionals’ communication experiences
SBAR increased efficient oral communication among healthcare workers (p=0.001). SBAR perceived by healthcare professionals as an effective and efficient way to structure patient reports. Written comments noted SBAR use facilitated improved patient safety.
Two 26-bed hospital surgical wards in southern Sweden
Level IV
Cornell et al., 2014
Observations of shift reports, IDR before and after introduction of paper SBAR then electronic SBAR forms
Regarding shift reports: post-SBAR, time to complete shift report decreased with paper and electronic SBAR (p<0.01). Higher volume of information also exchanged with use of SBAR (p<0.01). Regarding IDR: post- SBAR implementation, patient reviews were more consistent and shorter (p<0.01).
Suburban hospital in mid-southern United States
n=36 RNs, IDR patient reviews
Level IV
De Meester et al., 2013
Pre/post-SBAR study using review of patient records for SBAR items during 48 hours before adverse event; questionnaires measuring nurse-physician collaboration, rate of SAEs performed
Post-SBAR implementation, unplanned ICU admissions increased from 13.1/1,000 to 14.8/1,000 (p=0.001); unexpected deaths decreased (p<0.001). No difference in cardiac arrest team calls noted. Perception of effective communication and collaboration increased. Using SBAR, nurses were more willing to call physicians. Increased unplanned ICU admissions most likely resulted from nurses identifying patient changes earlier, leading to more ICU admissions and fewer unexpected deaths.
16 medical- surgical wards 5 ICUs (491 beds) of Antwerp University Hospital (Belgium)
n=425 questionnaires, 207 SAE patient reviews
Level IV
Fabila et al., 2016
Pre/Post SBAR-PETS survey measurements of perceived sufficiency, clarity, accuracy of communication
Proportion of personnel indicating exchanged information was frequently or always sufficient increased (p<0.0001). The proportion of responses indicating received information was concise/clear increased 70.5% (p<0.0001). Proportion of participants who rarely or never found information received in report differed from the following clinical assessment increased 43.2% (p<0.001).
16-bed unit of KK Women’s and Children’s Hospital (830-beds, Singapore)
n=52 personnel (RNs and pediatric intensivists)
Level IV
continued on next page
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SBAR, Communication, and Patient Safety: An Integrated Literature Review
TABLE 1. (continued) Studies and Themes
Author/Date Methods Results Setting/Sample LOE Fay-Hillier et al., 2012
Students educated on SBAR followed by use in simulated setting in which they assessed a patient then reported to each other; post-SBAR qualitative peer evaluation/ team debriefing to assess effect of SBAR on perceptions of communication, patient safety
Peer feedback indicated students considered simulation experience with SBAR assistive in improving their communication and collaboration skills. All participating students indicated using SBAR tool for report helped them focus on patient safety.
Drexel University College of Nursing and Health Professions (Philadelphia, PA)
n=9 nursing students
Level IV
Joffe et al., 2013
RCT in simulated on-call setting: nurses contacted physicians regarding six adapted cases. Three cases were handled without SBAR (control), three with SBAR. Communication regarding specific situation cues and background cues was evaluated.
92 telephone calls reviewed. Most nurses reported situation cues (SBAR group 88%, control group 84%, p=0.6), but not background cues. Fewer background cues provided in SBAR cases (14% SBAR, 31% control, p=0.08). Simply providing SBAR forms did not ensure communication of key information in after-hours telephone calls.
University of Texas Health Science Center
n=22 nurse- physician pairs
Level II
Martin & Ciurzynski, 2015
NPs, RNs conducted joint patient assessments, discussed findings using SBAR structure; Huddle, SBAR, and Communication Observation Tool (HSCOT) and pre/post measurements via Collaboration and Satisfaction About Care Decisions – PEDS ED (CSACD) survey to assess teamwork, communication, RN job satisfaction
Joint patient evaluations occurred 83% of the time with minimal interruptions; 83% of RNs and 78% of NPs reported having great experience in joint evaluation, SBAR huddle. Mean communication score between RNs and NPs improved post-SBAR with corresponding improvements in perception of communication (no p-values reported). RN job satisfaction improved post-SBAR (no p-value reported).
Pediatric emergency department in academic medical center, western New York
n=32 personnel (RN and NP), 36 patient encounters
Level IV
McCrory et al., 2012
Pre/post-SBAR scoring of simulated handoff reports of decompensating pediatric patients given by pediatric interns to rapid responder; two blinded reviewers assessed recordings for information inclusion, information order, elapsed time of handoff.
Mean score of handoffs increased in post- intervention scenarios (p<0.001); current situational information prioritized above background information in post-intervention scenarios (p<0.001); duration of handoff increased in post-intervention scenario (p=0.004), while elapsed time from start of handoff to time intern stated essential content item decreased post-SBAR (p<0.001); Pearson correlation coefficient between reviews 0.94 (p<0.001)
Johns-Hopkins University Hospital Simulation Center
n=26 pediatric interns, 52 handoff recordings
Level IV
Mitchell et al., 2013
Pre/post SBAR measurements via observation and blinded assessments of senior resident presentations at weekly surgical conferences using a validated assessment tool, faculty assessors with sufficient interrater reliability, survey assessments of user satisfaction, multiple-choice questionnaires assessing educational outcomes of conference attendees
Presentation quality improved significantly post-SBAR (p=0.002), resulting in clearer delivery of key information; user satisfaction surveys indicated satisfaction with SBAR structure (all scores ≥ 3 on 5-point Likert scale); additional free-text comments universally indicated presenters considered SBAR format simple to use, helpful in structuring presentations; educational outcomes of attendees improved post-SBAR (p<0.0002).
Oregon Health & Science University
n=66 senior resident presentations/ user-surveys, 224 quality assessments, 1,247 multiple choice questionnaire responses
Level IV
continued on next page
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TABLE 1. (continued) Studies and Themes
Author/Date Methods Results Setting/Sample LOE Nagammal, Nashwan, Nair, & Susmitha, 2017
Validated Handover Evaluation Scale to assess current nurse perception of SBAR handover structure
95.1% of nurses agreed SBAR followed a logical sequence, with 91.2% expressing satisfaction with SBAR structure and 88% recommending SBAR use in other areas of the hospital. 81.4% reported quality of information received via SBAR structure was good and 56.9% of nurses identified perceived reduction in communication errors after using the SBAR structure.
National Center for Cancer Care and Research Specialty Hospital (74 beds, Qatar)
n=102 staff nurse surveys
Level IV
Panesar, Albert, Messina, & Parker, 2016
Medical record reviews of all admitted patients during the three phases of paper chart documentation, EMR, and electronic SBAR note documentation to assess presence and completion of documentation. Each study period took place 3 months after introduction of each phase.
During paper chart documentation phase, 22/173 charts contained event notes vs. 28/197 during EMR phase and 34/172 during SBAR, indicating a nonstatistically significant increase in documentation during SBAR phase (p=0.07). The mean completeness of documentation during paper chart documentation phase was 2.23/4, compared to 2.57 during EMR phase, 3.24 during transition from EMR to SBAR phase, and 4/4 during SBAR phase (p<0.0001). Additionally, during SBAR-only phase documentation of notification of attending physician and bedside nurse increased to 100% (p=0.0001), indicating increased communication among resident physician, attending physician, and bedside nurse. Use of an electronic SBAR note was associated with increase in frequency of event documentation. Pre-defined fields of the SBAR note prompted residents to input appropriate information accordingly, resulting in increased completion of documentation.
12-bed pediatric ICU in University Children’s Hospital (Stony Brook, NY)
n=542 chart reviews (173 paper chart phase, 197 EMR phase, 172 SBAR phase)
Level IV
Randmaa et al., 2016
Pre/post SBAR audio recordings and observations assessing information recall, interruptions, and disruptions in-task taken in a control and intervention group
In intervention group, information recall increased from 43.4% pre-SBAR to 52.6% post-SBAR (p=0.0004), compared to control group scores of 51.3% and 52.6% respectively (p=0.725). Structure of verbal reports also improved significantly in intervention group (p=0.028), but did not in comparison group (p=0.889). Results indicated receivers of report may remember more when report is formatted to a predictable structure common to all parties.
PACU in two Swedish Hospitals
n=164 patient handoffs (72 personnel members including RNs, anesthesiologists, CRNAs)
Level III
Randmaa et al., 2014
Pre-post-SBAR comparisons of incident reports related to communication and measurements of staff perception of communication via pre/post surveys were taken in intervention and control groups
In intervention group, proportion of incident reports due to communication errors decreased from 31% to 11% (p<0.0001). Staff perception of “between group communication accuracy” improved (p=0.039) as did perception of organization’s safety climate (p=0.011).
Anesthetic clinics in two Swedish hospitals (type of hospital not specified)
n=139 (intervention), 91 (control)
Level III
continued on next page
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SBAR, Communication, and Patient Safety: An Integrated Literature Review
TABLE 1. (continued) Studies and Themes
Author/Date Methods Results Setting/Sample LOE Raymond & Harrison, 2014
Pre/post-SBAR telephone audits to assess SBAR use and pre/post qualitative questionnaire regarding communication administered to nurses and physicians
Telephone audit demonstrated SBAR use increased (no p-values reported); post-SBAR questionnaire results indicated SBAR use improved ease of communication and confidence, resulted in improved quality of patient care.
75-bed NICU, Groote Schuur Hospital (Cape Town, South Africa)
n=50 telephone audits
n=21 nurses, 17 physician questionnaire respondents
Level IV
Vardaman et al., 2012
Qualitative case studies of two hospitals implementing SBAR via semi-structured interviews, observation of nursing activities, review of documents pertaining to implementation of SBAR
Four additional uses for SBAR identified beyond its use as a communication tool: schema formation (mental models impacting response to situations, mental habits), development of legitimacy (especially helpful for new nurses calling physicians), development of social capital (trust developing from individual’s relationship network), and reinforcement of dominant logics (templates to guide cognition); concluded SBAR may be valuable to professionals outside nursing (administrators, unlicensed personnel, other healthcare professionals).
339-bed acute- care suburban hospital and 140- bed suburban women’s hospital (Baptist Health Systems, MS) n=80 interviews with RNs, managers, physicians
Level IV
Wang et al., 2015
Pre/post SBAR workshop questionnaire assessing performance under each SBAR domain, self-perception of performance, ability in clinical practice
Performance scores improved significantly (p<0.01); students’ self-perceived abilities regarding communication and SBAR also demonstrated significant improvement (p<0.01); 93.8% of students also indicated they would use SBAR in future clinical practice.
Fudan University School of Nursing (Shanghai, China) n=18 master’s degree nursing students
Level IV
Wentworth et al., 2012
Pre/post SBAR surveys assessing ease of use, fit within workflow, timeliness of handoff, usefulness for routine patients, perceived value, ability to ask questions
Proportion of staff agreeing patient handover took place between 1 and 6 minutes increased post-SBAR (no p-value reported); nurses also agreed SBAR tool was reliable standard method for handing off patients without interrupting workflow (no p-values reported).
33-bed progressive care unit, 6-room electrophysiology laboratory, 6-room cardiac catheterization laboratory
n=51 nurse surveys
Level IV
CRNA = certified registered nurse anesthetist, EMR = electronic medical record, ICU = intensive care unit, IDR = interdisciplinary rounding, LOE = level of evidence, NICU = neonatal intensive care unit, NP = nurse practitioner, PACU = postanesthesia care unit, RCT = randomized controlled trial, RN = registered nurse, SAE = significant adverse event, SBAR-PETS = situation-background- assessment-recommendation pre-handover equipment handover timeout sign-out
Note: Each article graded using Melnyk’s hierarchy of evidence (Melnyk & Fineout-Overholt, 2015)
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Use of SBAR Creates a Common Language for Communication of Key Patient Care Information.
When used to guide information exchange between nurses and physi- cians, SBAR bridges the communica- tion gap that may exist between the two professions due to different communication styles (Panesar, Albert, Messina, & Parker, 2016; Randmaa, Martensson, Swenne, & Engström, 2014). In addition, use of the SBAR tool temporarily flattens the hierarchy perceived in some healthcare settings. This creates more effective channels of commu- nication be tween providers (De Meester, Verspuy, Monsieurs, & Van Bogaert, 2013; Vardaman et al., 2012).
Historically, nurses and physi- cians have been taught to communi- cate using styles suited to the needs and thought processes of their respective professions (Raymond & Harrison, 2014). Nurses as direct caregivers tend to communicate using a subjective, narrative style that reflects the continuous flow of information received in the perform- ance of their daily responsibilities (Westwood et al., 2012). In contrast, physicians tend to communicate via an objective, headline approach that echoes the action-oriented method of traditional medical education in which expertise of the diagnosis and treatment of the disease demands quick action based on the objectivity of current evidence (Westwood et al., 2012). Professionals’ use of different styles can result in miscommunica- tion or omission of key patient care information that may jeopardize patient safety. The SBAR framework combines the communication styles of nurses and physicians, establish- ing a method for handoff reports that promotes effective information- al ex change between the members of the two professions (Panesar et al., 2016; Raymond & Harrison, 2014).
Results of a correlational descrip- tive study (Panesar et al., 2016) indicated use of SBAR by nurses and physicians creates a shared mental model between the two professions which leads to enhanced communi- cation. In addition, a foundational case study found the recommenda- tion portion of the SBAR tool
improved the situational awareness of physicians by allowing them to view the patient through the eyes of the direct caregiver (Haig, Sutton, & Whittington, 2006). This further enhanced patient safety and com- munication between providers.
These findings were confirmed by another correlational descriptive study in which use of the SBAR tool to guide information exchange resulted in emphasis on situational facts over ancillary information and improvement of overall hand- off communication (McCrory, Aboum atar, Custer, Yang, & Hunt, 2012). The integration of profes- sional communication styles in the SBAR tool contributes to a more holistic pro cess for communication, adding standardization to nurses’ individualized assessment report and increasing the situational awareness of physicians (Haig et al., 2006; McCrory et al., 2012).
As a communication structure used by all healthcare professions, the SBAR communication tool also serves to eliminate temporarily the perceived hierarchies of the health- care system (De Meester et al., 2013; Vardaman et al., 2012). With con- sistent use in an organization, the SBAR tool prevents the context of handoff exchanges from being one in which the speaker feels pressured to edit the content of a report due to the perceived hierarchical status of the receiver. Using the SBAR tool, nurses in one correlational descrip- tive study (De Meester et al., 2013) became more willing to contact the attending physician earlier regard- ing a change in patient condition; they indicated use of the SBAR tool eliminated their fear of “looking stupid” (p. 1195) when speaking to a physician with higher perceived status. This response on the part of nurses subsequently led to in - creased patient transfers to inten- sive care units (p=0.001) with a cor- responding decrease in the number of unexpected patient deaths (p<0.001). Similarly, qualitative case studies of SBAR implementation (Vardaman et al., 2012) found nurs- es were more comfortable commu- nicating with physicians as a result of developing legitimacy when using the SBAR tool.
However, simply providing SBAR
forms does not ensure communica- tion of pertinent information. A randomized controlled trial (Joffe et al., 2013) found situation cues remained consistent in verbal reports between disciplines (p=0.6) while fewer background cues were reported when the SBAR tool was used (p=0.8). While these results were not statistically significant, they were consistent with previous findings that use of SBAR leads to an emphasis on current situational information with less focus on background (McCrory et al., 2012).
Use of SBAR Increases Confidence of Speaker and Receiver of Handoff Report.
Standardizing the format elimi- nates the question of how to con- duct a handoff report by giving the speaker an established method for communication, thus improving his or her confidence in the ability to provide an effective report (Ray - mond & Harrison, 2014; Wang, Liang, Blazeck, & Greene, 2015). In two correlational descriptive studies assessing the consistency of handoff reports between nurses using SBAR, authors concluded handoffs for- matted according to the SBAR tem- plate were more consistent (Cor - nell, Townsend-Gervis, Yates, & Vardaman, 2014; Wentworth et al., 2012). Because the order of the report is uniform regardless of the profession, experience, or position of the users, use of the SBAR tem- plate enables the speaker and the receiver to focus on the information being exchanged (Fay-Hillier, Reg - an, & Gallagher Gordon, 2012; Randmaa, Swenne, Martensson, Högberg, & Engström, 2016).
Consistent use of SBAR also aids in identification and correction of omitted information, subsequently improving the receiver’s confidence in the information contained in the handoff report (Blom, Petersson, Hagell, & Westergren, 2015). In a quasi-experimental study by Randmaa and colleagues (2014), use of the SBAR framework by nurses and physicians decreased the receiv- er’s impression of needing to consult the medical record to verify informa- tion communicated in the handoff report; the receiver felt more confi- dent in the information provided. In
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a pre/post survey and observational study, Martin and Ciurzynski (2015) found use of SBAR by nurses and nurse practitioners in a pediatric emergency department resulted in more concise reports due to the anticipated nature of SBAR. Overall, implementation of SBAR leads to a more concise report in which omis- sions are identified more easily and information is anticipated readily (Blom et al., 2015; Martin & Ciur - zynski, 2015).
Use of SBAR Improves Efficiency, Efficacy, and Accuracy of Handoff Report.
Use of the SBAR communication template gives the handoff report a standardized format that becomes habitual for users, decreasing the time on non-pertinent tasks during a report and increasing its efficacy (Cornell et al., 2014; Wentworth et al., 2012). Performing a task the same way every time facilitates improved proficiency for the user. In a correlational descriptive study, implementation of the SBAR tem- plate for use during nurse-to-nurse shift handoff and interdisciplinary rounds resulted in increased time spent on shift report tasks, from 14.3 minutes pre-SBAR to 21.5 min- utes (paper) and 25.4 minutes (elec- tronic) post-SBAR (p<0.01). Simul - taneously, total time to complete the shift report decreased from an average of 53 minutes pre-SBAR to 38.1 post-SBAR (p<0.01) (Cornell et al., 2014). Authors also concluded consistent use of SBAR during inter- disciplinary rounding and nurses’ shift handoff report resulted in more focused patient reviews and shift reports, with an increased vol- ume of information exchanged and reduced time spent on non-perti- nent information. While decreasing the time for handoff report was not the primary goal, increasing report efficiency and reduced time spent on extraneous and unnecessary patient information allowed health- care professionals to dedicate more time to activities related directly to patient care.
Consistent use of the SBAR tech- nique also improved the accuracy, clarity, and efficacy of information exchanged during report (Blom et al., 2015; Randmaa et al., 2014). The
simplicity and consistency of the SBAR communication tool facilitates professionals’ ability to differentiate the information needed for safe patient care and then convey the information correctly (Randmaa et al., 2014). In a survey study, use of the SBAR tool was reported by nurses to improve the sufficiency (p<0.0001), clarity (p<0.0001), and accuracy (p<0.001) of the content in the handoff report (Fabila et al., 2016). Use of the SBAR tool during handoffs in a quasi-experimental study decreased the proportion of incident reports related to misunder- standing, misinterpretation, or omis- sion of information from 31% to 11% (Randmaa et al., 2014). Likewise, another correlational de - scriptive study showed SBAR use resulted in improved clarity in the delivery of key information (p=0.002) (Mitchell et al., 2013). By providing a standardized expecta- tion for the structure of the handoff report, use of the SBAR tool guides the speaker in giving a focused, rele- vant, factually correct report.
Use of SBAR Improves the Perception of Effective Communication and Is Well- Received Among Healthcare Staff.
The SBAR framework is consid- ered by nurses and physicians to be an effective method for organizing the handoff report. In a study using pre/post SBAR implementation ques tionnaires to evaluate health- care providers’ perceptions of com- munication, Blom and co-authors (2015) concluded introduction of the SBAR tool resulted in improved perceptions of communication in nurse-to-nurse and nurse-to-physi- cian scenarios. Implementation of an SBAR document (SBAR-PETS) for handoff between anesthetists and non-anesthetist personnel in anoth- er study also resulted in an increase in the proportion of survey respon- dents indicating exchanged infor- mation was frequently or always suf- ficient (p<0.0001) (Fabila et al., 2016). Additionally, Nagammal, Nashwan, Nair, and Susmitha (2017) found 95.1% of nurses con- sidered SBAR to follow a logical order, with 91.2% expressing satis- faction with the tool and 88% rec-
ommending its use for handoff. Authors of other quasi-experimental studies also identified the common perception among healthcare staff that use of the SBAR tool during handoff increases communication and collaboration (De Meester et al., 2013; Martin & Ciurzynski, 2015). These findings are clinically signifi- cant because gaining the confidence of healthcare providers is important in motivating them to use the SBAR protocol (Blom et al., 2015). The positive perception of the SBAR tool among healthcare providers increas- es the likelihood of its use and facil- itates a focus on communication and patient safety (Blom et al., 2015; Fabila et al., 2016; Nagammal et al., 2017).
Discussion Benefits of using the SBAR com-
munication framework are of two types: those that result from the standardization of the handoff report process, and those that spring from characteristics of the tool itself. The impact of SBAR on the hierarchi- cal barriers, confidence of the users, length of report time, and accuracy of exchanged information stem chiefly from the provision of a stan- dardized process for reporting (De Meester et al., 2013; Panesar et al., 2016; Randmaa et al., 2014). In addi- tion to benefits from standardiza- tion, use of the SBAR template pro- duces several primary advantages derived directly from characteristics unique to SBAR. Specifically, use of the SBAR technique establishes a process for handoff reporting that functions across disciplines, im - proves the perception of communi- cation by health providers, and is well-received by healthcare provi - ders (Blom et al., 2015; Fabila et al, 2016; Nagammal et al., 2017; Randmaa et al., 2014). Overall, use of the SBAR tool is a simple, effective way to create systemic change in healthcare communication, ulti- mately leading to improvement in the system’s safety culture (Nagam - mal et al., 2017).
Strengths and Limitations Only one randomized controlled
study was found in the literature
SBAR, Communication, and Patient Safety: An Integrated Literature Review
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search (Joffe et al., 2013). Because of the lack of controlled studies, the bulk of the articles included in the integrated literature review cannot be used to conclude causation between use of SBAR and the pro- posed variables. Future research should focus on controlled inter- ventional studies that assess effects of SBAR use on communication and patient safety.
Implications for Nursing Practice
Communication in health care has been established as a leading root cause of sentinel events, with times of patient handoff particular- ly prone to informational omission and misunderstanding (Staggers & Blaz, 2013; The Joint Commission, 2015). Use of the SBAR technique thus has two primary implications for medical-surgical nursing.
First, SBAR should be imple- mented by nurses as a guide for all handoff communication of patient care information (e.g., nurse-physi- cian, inter-unit or inter-facility transfers, or nursing shift change). Improving the quality of communi-
cation during patient handoffs should be considered a nursing pri- ority given the role of communica- tion in patient safety (The Joint Commission, 2015). Second, educa- tion regarding proper use of the SBAR tool should be added to nurs- ing curricula to integrate this method of communication into practice during clinical experiences. Given the frequency with which nurses participate in handoff com- munication, the incorporation of evidence-based methods should be taught intentionally through nurs- ing education.
Conclusion Errors in communication contin-
ue to be a contributing factor in adverse patient events in healthcare systems (The Joint Commission, 2015). The systemic nature of the problem of miscommunication between healthcare providers sup- ports the need for a standardized communication method. The SBAR tool is a simple, effective method for communication that operates across disciplines and is well- received by healthcare professionals
(Blom et al., 2015; Nagammal et al., 2017). Use of the SBAR tool thus should be implemented systemati- cally to improve healthcare com- munication and create a safer patient care environment.
REFERENCES Blom, L., Petersson, P., Hagell, P., & Wester -
gren, A. (2015). The situation, back- ground, assessment and recommenda- tion (SBAR) model for communication between health care professionals: A clinical intervention pilot study. Inter - national Journal of Caring Sciences, 8(3), 530-535.
Cornell, P., Townsend-Gervis, M., Yates, L., & Vardaman, J.M. (2014). Impact of SBAR on nurse shift reports and staff rounding. MEDSURG Nursing, 23(5), 334-342.
Curry-Narayan, M. (2013). Using SBAR com- munications in efforts to prevent patient rehospitalizations. Home Healthcare Nurse. 31(31), 504-517. doi:10.1097/ NHH.0b013e3182a87711
Daniel, L., & Wilfong, D. (2014). Empowering interprofessional teams to perform effec- tive handoffs through online hybrid simu- lation education. Critical Care Nursing Quarterly, 37(2), 225-229. doi:10.1097/ CNQ.0000000000000023
De Meester, K., Verspuy, M., Monsieurs, K.G., & Van Bogaert, P. (2013). SBAR improves nurse-physician communica- tion and reduces unexpected death: A pre and post intervention study.
Instructions For Continuing Nursing Education Contact Hours
SBAR, Communication, and Patient Safety: An Integrated Literature Review
Deadline for Submission: October 31, 2019 MSN J1713
To Obtain CNE Contact Hours 1. For those wishing to obtain CNE contact hours, you must read the article and
complete the evaluation through the AMSN Online Library. Complete your evaluation online and print your CNE certificate immediately, or later. Simply go to www.amsn.org/library
2. Evaluations must be completed online by October 31, 2019. Upon completion of the evaluation, a certificate for 1.2 contact hour(s) may be printed.
Learning Outcome After completing this learning activity, the learner will be able to discuss the use of SBAR as a tool for improving communication and patient safety.
Learning Engagement Activity Evidence of this integrated literature review about SBAR identified four recurring themes relate to the use of the SBAR framework and the effect its use has on communication and patient safety. Can you recall the four themes?
The author(s), editor, editorial board, con - tent reviewers, and education director reported no actual or potential conflict of interest in relation to this continuing nursing education article.
This educational activity is jointly provided by Anthony J. Jannetti, Inc. and the Academy of Medical-Surgical Nurses (AMSN).
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SBAR, Communication, and Patient Safety: An Integrated Literature Review
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