Clinician Module
OBJECTIVESOBJECTIVES
Recognize the need for a structured communication processDefine SBARDescribe how improving communication will support reducing avoidable acute care hospitalizationsApply SBAR technique into daily practice
Changes in payment systemBurdensome paperwork/data collectionHigher acuity levelCommunication methods beyond face to face (e.g. phone, fax, email)
SS = SituationB B =
BackgroundAA =
AssessmentR R =
Resolution
IHI, 2006
US Navy Nuclear Submarine
Communication ModelCommunication Model
THE NEED:
The ability to communicate clearly, effectively and efficiently in just seconds
How are submarines & healthcare operations alike?•Exist in “harms’ way”•Require timely action to avert disaster• 24X7 operations•Lots of turnover and cultural diversity•Deal with fear, fatigue, interruptions, distractions•At the root of their adverse outcomes unclear, in concise, or inaccurate information
Institute for Healthcare Improvement Focus on improving health care
Modified the Navy’s SBAR R – Recommendation rather than
Resolution
Condenses messagesPromotes critical thinkingInterdisciplinary communicationPhysician communication
S-B-A-RS-B-A-R STANDS FOR … STANDS FOR …SS = Situation = Situation
What is going on with the patient
BB = Background = BackgroundWhat is the clinical background information that is pertinent to the situation
AA = Assessment = AssessmentWhat I think—conclusionsWhat I think—conclusions
RR = Recommendation = Recommendation What is needed and in what time frame
SBARSBAR: PREPARATION: PREPARATION
Ensure Ensure all pertinent patient information is all pertinent patient information is available before you contact the available before you contact the physicianphysician
NameName Medical record number Age Diagnosis Medication list Allergies Vital signs Lab results Advance Directive
•40 patients a day•need to cue the physician to who we are and who the patient is• may only see our patients every couple months or less
SBARSBAR TECHNIQUE TECHNIQUE
((S) Situation:S) Situation: What is the situation you are reporting?
Identify self, agency, patient, patient
location
What is going on with the patient. A
concise statement of the problem
10-15 SECONDS only
SBARSBAR TECHNIQUE TECHNIQUE
(B) Background: (B) Background: CClinical background information that is pertinent to the situation
The admitting diagnosis and date of admission
List of current medications, allergies, IV fluids, etc.
Most recent vital signs
Lab results: provide the date and time test was done and results of previous tests for comparison
Advance Directive
(A)(A) AssessmentAssessment:: What are the clinician’s?What is the analysis ?Is this problem severe or life threatening?
SBARSBAR TECHNIQUE TECHNIQUE
(R) Recommendation(R) Recommendation: : What action/recommendation is needed to correct the problem?What solution can you offer the physician?What do you need from the physician to improve the patient’s condition?
SBAR: SBAR: ACTIVITY #1ACTIVITY #1
SBAR Interdisciplinary Communication
Example
SITUATION –
State what is happening at the present time that has warranted the SBAR communication.
Example: Hi, Kathy, this is Brian. I am calling to report that my patient, Mrs. L., has an elevated blood pressure this morning and admits to feeling very anxious.
BACKGROUND –
Explain circumstances leading up to this situation. Put the situation into context for the reader/listener.
Example: Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). There are no other abnormal symptoms are present during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks.
BACKGROUND –
Explain circumstances leading up to this situation. Put the situation into context for the reader/listener.
Example: Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). There are no other abnormal symptoms are present during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks.
BACKGROUND – Explain circumstances leading up to this situation. Put the situation into context for the reader/listener.
Example: Mrs. L’s blood pressure is 188/92 (R) up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). No other abnormal symptomatology evident during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks. . RECOMMENDATION – What would you do to correct the problem? Example: I would like you to notify the physician of these findings and ask if we can have a social worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s suspected panic attacks. I would also like you to visit the patient in the a.m. to assess her vital signs. I will plan to call the physician tomorrow with our findings to see if he would like to schedule Mrs. L for an office visit.
Assessment
State what is happening at the present time that has warranted the SBAR communication.
Example: “ Kathy, I think Mrs. L is anxious and might be having a panic attack. She states this is similar to ones she has had before.
RecommendationWhat would you do to correct the problem? Example: “I would like to notify the physician of these findings and ask if we can have a social worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s suspected panic attacks. I would also like to visit the patient in the a.m. to assess her vital signs. I will plan to call the physician tomorrow with our findings to see if he would like to schedule Mrs. L for an office visit.”
S-Hi, Kathy, this is Brian. I am calling to report that my patient, Mrs. L., has an elevated blood pressure this morning and admits to feeling very anxious.
B-Mrs. L’s blood pressure is 188/92 (R) which is up from 126/80, 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). There are no other abnormal symptoms are present during my assessment. The patient has verbalized that she is somewhat nervous and jumpy but denies any unusual activity or stress. She also has a history of panic attacks.
A-Kathy, I think Mrs. L is anxious and might be having a panic attack. She states this is similar to ones she has had before.
R-“I would like to notify the physician of these findings and ask if we can have a social worker referral for an evaluation to r/o psychosocial issues that may be causing Mrs. L’s suspected panic attacks. I would also like to visit the patient in the a.m. to assess her vital signs. I will plan to call the physician tomorrow with our findings to see if he would like to schedule Mrs. L for an office visit.”
HOW TO USE HOW TO USE SBARSBAR AT DHCHAT DHCH
Interdisciplinary Communication:
Voice mail/face to face
Hand offs
Report to managers and peers
Message to office staff to forward to physician
During case conferences
FROM THE PHYSICIAN…FROM THE PHYSICIAN…
“How the nurse communicates patient information will depend on whether I listen to the nurse or not.”
SBAR:SBAR: ACTIVITY #2 ACTIVITY #2
SBAR Physician Communication sample
The following example demonstrates using SBAR to communicate issues, problems or opportunities for improvement to physicians
SITUATION – State what is happening at the present time that has warranted the SBAR communication.
Example: This is Carol from Duke Home Care. We are seeing Mrs. L for pressure ulcer treatment. I am calling to report, Mrs. L, has an elevated blood pressure this morning. She also told me that she feels very anxious
BACKGROUND – Explain circumstances leading up to this situation. Put the situation into context for the reader/listener Example: Duke Home Health has been seeing Mrs. L for three weeks for care of a pressure ulcer. This is the first time her blood pressure has been elevated. Today her blood pressure is 188/92 (R); up from 126/80; 186/90 (L). Her pulse has increased from 64 bpm (regular rate and rhythm) to 98 bpm (regular rate and rhythm). No other abnormal symptoms evident during my assessment. The patient has verbalized that she is nervous and jumpy but denies any unusual activity or stress. She also stated that she has a history of panic attacks.
ASSESSMENT
What do you think the problem is?
Example: She has elevated blood pressure and pulse.
RECOMMENDATION –
What would you do to correct the problem?
Example: I can draw electrolytes and enzymes this morning and call you will the results. I am also requesting to have an order for a social worker to visit to r/o psychosocial issues. I will revisit Mrs. L tomorrow and contact you with our findings.
HOW TO USE THE HOW TO USE THE SBARSBAR FORM FORM WITH PHYSICIANSWITH PHYSICIANS
Script for phone call to physician’s officeFaxHand deliver
ACH CONNECTIONACH CONNECTION
Improving Physician Communications with
SBARSBAR
Physician understanding of
patient problem
Physician trust with clinician
Opportunity for early, appropriate intervention that
may reduce avoidable ACHACH