Situation, Background, Assessment, Recommendation Research Articles

The SBAR tool for communication and patient safety in gynaecology and obstetrics: a Tunisian pilot study

BackgroundIn healthcare, inadequate communication among providers and insufficient information transmission represent primary contributors to adverse events, particularly in medical specialties such as obstetrics and gynecology. The implementation of SBAR (Situation-Background-Assessment-Recommendation) has been proposed as a standardized communication tool to enhance patient safety. This study aims to evaluate the knowledge, attitudes, and practices related to SBAR communication through a pilot study conducted in a middle-income country.MethodsThis prospective longitudinal study took place in the gynecology-obstetrics department of a Tunisian university hospital from May to June 2019. All medical and paramedical staff underwent comprehensive theoretical and practical training through a 4-hour SBAR simulation. To gauge participants’ knowledge, anonymous multiple-choice questionnaires were administered before the training initiation, with a second assessment conducted at the end of the training to measure satisfaction levels. Two months later, the evaluation utilized questionnaires validated by the French National Authority for Health (HAS).ResultsAmong the 62 care staff participants in this study, a majority (89%) demonstrated a low level of knowledge regarding the SBAR tool. The majority (75.8%) expressed enjoyment with the training and indicated their intention to implement changes in their practice by incorporating the SBAR tool in the future (80.7%). Notably, over half of the participants (79%) expressed satisfaction with the training objectives, and 74% reported acquiring new information. Evaluation of the practice revealed positive feedback, particularly in terms of clarity, the relevance of communication, and the time spent on the call.ConclusionOur pilot study showed that the majority of professionals on the ward had little knowledge of the SBAR tool, a good attitude and a willingness to put it into practice. It is essential that healthcare managers and professionals from all disciplines work together to ensure that good communication practice is developed and maintained. Organisations, including universities and hospitals, need to invest in the education and training of students and health professionals to ensure good quality standardised communication.

Implementation of effective communication to realize patient safety in emergency installations

Communication is one of the factors of patient safety in hospitals. Especially effective communication carried out in the Emergency installations to provide special services to patients in critical conditions. This is important to pay attention to because it has an impact on regulating the number of patients precentages each year. Effective communication with emergency patients requires a specific approach and strategy, which is the focuses on this study. Objective: To identify the appropriate strategies for enhancing effective communication to ensure patient safety in the Emergency Installation. Method: A literature review was conducted using data from two database sources are ScienceDirect and Google Scholar. Results: The results obtained in this research, effective communication in the emergency installations is carried out accurately, completely, clearly, on time, and choosing words that are easy to understand, and pay attention to patients based on age groups and characters as interlocutors so that communication can be effective. Conclusion: Effective communication with patients in the emergency installations is supported by strategies and approaches that include Situation, Background, Assessment, Recommendation (SBAR) and Friendly, Audible, Collaboration (FEEL) to improve patient safety.

A survey on the effects of patient safety training programs based on SBAR and FMEA techniques on the level of self-efficacy and observance of patient safety culture in Iran hospital, Shiraz in 2022-2023.

Patient safety and medical personnel self-efficacy are among the main factors involved in providing quality health services. Moreover, safety culture in an organization is considered one of the most critical factors regarding patients' safety. Therefore, the present study aimed to determine the effects of patient safety programs based on Situation, Background, Assessment, Recommendation (SBAR) and Failure Model Effects Analysis (FMEA) techniques on self-efficacy and patient safety culture in Iran Hospital of Shiraz in 2022-2023. This two-stage quasi-experimental study was conducted in 2022-2033. Considering inclusion criteria, the present study included 80 nurses working in Iran Hospital. The participants were divided into groups of SBAR (40 participants) and FMEA (40 participants). All the data were collected using a Hospital Survey on Patient Safety Culture questionnaire and Sherer General Self-Efficacy Scale. Then, the collected data were analyzed using SPSS 13, Fisher's exact test, paired t-test, and independent t-test with a significant level of P < 0.05. The mean score of total patient safety culture between the two groups was insignificant before the intervention (P = 0.58). However, it was more significant in the FMEA group than the SBAR group after the intervention (P < 0/05). In addition, the mean self-efficacy score between the two groups was insignificant before the intervention (P = 0.80). However, after the intervention, the mean score of the FMEA group was significantly higher than the SBAR group (P < 0.05). According to the findings of this study, there is a meaningful relationship between patient safety training programs based on SBAR and FMEA techniques on patient safety and self-efficacy of nurses; however, FMEA training has more positive effects on self-efficacy and patient safety compared to other techniques. As a result, these techniques, along with other plans, are recommended to authorities in order to help improve patient safety.

Development and effectiveness of the stepwise handoff protocol based on the SBAR for long-term care hospital nurses: A nonequivalent control-group pre-posttest design

Purpose: This study aimed to develop and examine the effectiveness of the stepwise handoff protocol based on the situation, background, assessment, recommendation (SBAR) application for long-term-care hospital nurses. Methods: A nonequivalent control group pre-posttest design was used for this study. There were 23 subjects in the experimental group and 23 subjects in the control group. Using SPSS Statistics 21.0, data were analyzed by descriptive statistics, independent t-test, and repeated measure ANOVA. Results: The effectiveness of the stepwise handoff protocol based on the SBAR for long-term-care hospital nurses showed a difference in the communication self-efficacy by group (F=8.81, p=.005), by time (F=11.43, p&lt;.001), the interaction effect of group point and time (F=9.67, p&lt;.001), the communication clarity by group (F=10.05, p=.003), by time (F=5.74, p=.005), interaction effect between group point and time (F=3.37, p=.039), and the quality of handoff by group (F=12.48, p=.001), by time (F=7.03, p=.010), and interaction effect between group point and time (F=4.29, p=.042). Conclusion: The stepwise handoff protocol based on the SBAR is expected to improve the work by systematically implementing the transfer of long-term-care hospital nursing to increase nurses’ job efficiency.

Experience of health workers in improving patient safety in hospitals through interprofessional collaboration: study qualitative

Introduction: Patient safety is a global problem because patient safety incidents that occurare estimated to be 134 million incidents due to unsafe care and 2.6 million resulting indeath. Indonesia recorded a patient safety incident rate of 23.5%, so interprofessionalcollaboration is necessary to minimize this condition.Objective: This study aims to identify the experience of health workers in improvingpatient safety in hospitals through interprofessional collaboration. The method in this studyis a qualitative design with an interpretive descriptive approach.Methods: The method in this study is a qualitative design with an interpretive descriptiveapproach. The method in this study is qualitative with a descriptive-interpretative approachdesign. Implementation method with FGD on five professional health workers.Result: The results of the study contained 8 (eight) themes showing the experience ofhealth workers in improving patient safety in hospitals through interprofessionalcollaboration including understanding health workers in improving patient safety,implementation of patient safety for health workers in interprofessional collaboration,hospital management support, obstacles and expectations health workers in improvingpatient safety through interprofessional collaboration.Conclusion: The results of the study contained the experience of health workers on theimplementation of patient safety in hospitals through interprofessional collaboration,namely identifying actions in providing services with uniform documentation and alsocoordinating actions according to Standart Operastional Procedur (SOPs), creatingcommunication according to Situation, Background, Assessment, Recommendation (SBAR),joint commitment in providing services in hospitals, uniform training in hospitals, reducingbarriers in both personal and management services, awareness, interest and motivationfrom each profession, facilities that support the implementation of patient safety open andtransparent system, monitoring evaluation regulary and facilitating staff.

Implementation of Effective Communication as an Effort to Improve The Quality of Service in North Sumatra University Dental and Oral Hospital

Communication is the most important aspect of collaboration between professionals consisting of doctors, nurses, pharmacists, medical records, and patients. In fact, 70–80% of errors in health services are caused by poor communication and a lack of understanding between team members or between professionals. Lack of communication can also cause delays in serving patients and errors in handling patients. One of the ways to provide Effective Communication training is through using the Situation Background Assessment Recommendation (SBAR) method. The purpose of this study was to create and correct effective communication to improve service quality and patient safety at the Dental and Oral Hospital of North Sumatra University. The research method used a qualitative approach, and the informants were all the staff or employees at the Dental and Oral Hospital of North Sumatra University. Methods of data collection were carried out by direct observation and giving questionnaires before and after the communication training. The changes observed or measured in the research were before and after the SBAR training, that is the increase and the change in the behaviour of the officers. The result of this study shows that respondents had fairly good percentage results, with knowledge of 73.65% and applying effective communication with the SBAR method of 57.49%. Concluded that Therefore, effective communication is one of the indicators for monitoring hospital quality and patient safety.

Supporting nurses in acute and emergency care settings to speak up.

Nurses' competence and confidence in raising concerns with senior clinicians is integral to patient safety and the quality of patient care. If nurses do not speak up when needed it can contribute to incidences of failure to rescue. There are many barriers to nurses speaking up in busy emergency departments and complex major trauma patient cases. Assessment and communication tools such as the SBAR (situation, background, assessment, recommendation) approach and communication techniques such as graded assertiveness can help to overcome some of these barriers. This article uses a case study to discuss how nurses can respectfully but efficiently escalate their concerns to the trauma team leader. It describes barriers to nurses speaking up and tools that can support nurses to speak up, with a focus on graded assertiveness.

In-service training program about Situation, Background, Assessment, Recommendation (SBAR) and patient safety

In-service training program about Situation, Background, Assessment, Recommendation (SBAR) and patient safety

Structured Referral Call Handling Process Improves Neonatal Transport Dispatch Times.

In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handling process change to expedite transport team mobilization. This study compares the impact of this change on neonatal transport decision to dispatch and mobilization times. This retrospective cohort study was conducted using a historical cohort of neonates referred for transportation between January 2017 and December 2021. The "dispatch time" (DT) was the time from the start of consultation to the time a decision to dispatch the transport team was made, whereas "mobilization time" (MT) referred to the time from start of consultation to the time the team departed the home base. In 2019, a DT target of <3 minutes was implemented to meet a target MT of <15 and <30 minutes for emergent and urgent high-risk transport referral calls, respectively. In 2021 use of the "Situation" component of the SBAR (Situation, Background, Assessment, Recommendation) communication tool was introduced with the transport team asking five questions to determine need for mobilization. Data between 2017 and 2018 represented the preintervention period, 2019, the "washout" period for implementation, and 2020 to 2021, the postintervention period. Data were analyzed to determine trends in DT and MT. The DT was reduced from a median of 5 to 3 minutes following intervention (p < 0.001). DT target goal of 3 minutes was achieved in 67.08% of calls compared with 26.24% in the preintervention period, (p < 0.001). The team achieved MT target goals in 42.71% of urgent and emergent transfers compared with 18.05% prior to intervention (p < 0.001). Introduction of a time-sensitive referral call handling process improved dispatch and mobilization time of the neonatal transport team. · Time-sensitive triaging of neonatal transport referrals improves dispatch and mobilization time.. · A structured referral call handling process improves the efficiency of neonatal transport decision-making.. · Dedicated neonatal transport vehicles are likely to improve neonatal transport mobilization time..

Transferring critical pediatric patients from emergency department to intensive care: A quality improvement initiative

BackgroundTransfer of care, moving hospitalized patients between care areas, is a critical point of vulnerability for healthcare organizations. Patient information handoff is an essential activity occurring frequently in hospital environments. Poor communication has been linked with adverse events and poor patient outcomes. This evidence-based quality project aimed to enhance the handoff process between the Emergency Department (ED) and Pediatric Intensive Care Unit (PICU) by standardizing transfer of care steps. This was accomplished through customizing a reporting tool to contain all the information the receiving department deemed necessary for safe patient care. MethodsA customized situation, background, assessment, recommendation (SBAR) form handoff tool was developed for ED to PICU transfers. This SBAR tool included information that PICU nurses identified as critical to transfer of care. Nurse perceptions were surveyed pre- and post-implementation. Patient safety event reports were tracked to evaluate events related to transfer of care before and after the practice change. FindingsAn increased number of PICU nurses agreed the customized handoff tool was complete and organized. Additionally, more nurses agreed that handoff gave all information needed to safely care for critically ill patients transferred from the ED. Lastly, bedside patient checks increased, and patient safety events related to transfer of care decreased. DiscussionThis project demonstrated that implementation of a standardized transfer of care process coupled with a customized handoff tool increased PICU nurse perceptions that handoff was organized, and all information needed to safely care for critically ill patients was conveyed. Application to practiceTransfer of care processes between the ED and PICU should be standardized. The use of customized tools may improve information exchange between nurses and ensure that all vital patient information is communicated.

Adequacy of intraoperative patient handover

Background: Intraoperative handover is essential for patient safety as failure in communication may lead to morbidity and mortality. Effective handover plays a key part in ensuring the continuity, quality, and safety of patient care.1 SBAR (situation, background, assessment, recommendation) provides a structured handover approach and is endorsed by the hospital policy.2 It can make handovers quicker yet more effective, thereby releasing more time for clinical care. Handover should be structured to ensure continuity of care.3 The aim of this hospital Quality Improvement Project was to compare the handover given between anaesthesia residents using an internationally defined handover template (Association of Anaesthetists), followed by a training package and re-audit. Methods: Eight operating lists on 5 days with a total of 120 handovers were checked for the information given at the time of handover. This was cross checked with the international standards on a proforma. After the first audit, residents received training and a checklist was provided in each operating room. Later on, a loop audit was done to check compliance. This time the total number of handovers assessed was 131. Results: There were total 23 residents when this audit was performed; 26.1 % (n=6) were female and 73.9% (n=17) were male. In the first audit, compliance with mentioning the situation was 61.7% (n=74); background was mentioned in 9.1% (n=11) cases; assessment was provided in 5% (n=6) of the times; recommendations were given in 43.3% (n=52) of the cases. The loop audit after the training package showed improvement in the results (Fig. 4). The compliance was as follows: situation 87.8% (n=115), background 93.9% (n=120), assessment 90.1% (n=118), and recommendations were 100% (n=131). Conclusions: A comprehensive and standardised handover of important patient information is vital for ensuring continuity of care, patient safety, and avoids poor/inadequate communication. By completing an audit cycle, we improved the quality of handover. 1.Boet S, Djokhdem H, Leir SA, Théberge I, Mansour F, Etherington C. Br J Anaesth 2020; 125: 605–132.Oswal S, Ingham C, Sykes A. Postoperative handover protocol. Bradford Teaching Hospitals NHS Foundation Trust. 2018. (Accessed 20/03/2023)3.Jullia M, Tronet A, Fraumar F, et al. Eur J Anaesthesiol 2017; 34: 471–6

The value of Pediatric Early Warning Score combined with SBAR in neonatal pneumonia nursing: A retrospective cohort study.

To observe the effect of the Pediatric Early Warning System (PEWS) score combined with the situation-background-assessment-recommendation (SBAR) shift communication system in neonates with severe pneumonia in the pediatric intensive care unit. A total of 230 neonates admitted to the pediatric intensive care unit of our hospital from January 2018 to January 2021 were enrolled in this study. Participants were divided into an experimental group (110 patients, PEWS score combined with SBAR shift communication system) and a control group (120 patients, routine diagnosis and treatment and shift change). The early recognition rate, incidence of handover problems, and prognosis of critically ill children in the 2 groups were analyzed. Compared to the control group, the correct recognition rate of disease observation and early recognition rate of critically ill children in the experimental group were significantly higher, and the incidence of handover problems was significantly lower (P < .05). There was no significant difference in the incidence of asphyxia, heart failure, and toxic encephalopathy between both groups. The application of the PEWS score combined with the SBAR shift communication system can facilitate timely identification of deterioration of the condition of children with severe pneumonia, reduce handover problems, and help to implement interventions or rescue according to the changes in a patient's condition, which may be beneficial in improving the patient's prognosis.

Effective handovers on escalation of care for the deteriorating patient.

Evidence suggests that improvements in clinical practice are required to ensure that deteriorating patients are rapidly identified and assessed in a systematic manner. The important step of escalating care involves a detailed handover to the most appropriate colleague so that interventions can be put in place to reverse or optimise the patient's condition. However, multiple issues can hinder this handover process, including a lack of confidence among nurses and suboptimal team dynamics or cultures. Using structured communication tools such as situation, background, assessment, recommendation (SBAR) can assist nurses in delivering a handover that results in the desired outcome. This article explains the steps involved in identifying, assessing and escalating the care of deteriorating patients, and describes the components of an effective handover.

Structured patient handover in high-risk areas : Evidence and recommendations for the practical implementation

The perioperative setting is ahigh-risk environment which is particularly susceptible to communication deficits and errors. The situation, background, assessment, recommendation (SBAR) approach provides an intuitive guideline for team communication, which is associated with an improved quality of the handover. The German Society for Anaesthesiology and Intensive Care Medicine (DGAI) has updated its recommendations in March 2022 and continues to endorse the use of the SBAR template. The impact of tools used for structured communication during patient handover are often studied in the context of alarger bundle of measures. The SBAR template is one option for establishing structured communication in clinical practice. Successful implementation is supported by clearly defined standard workflows to promote consistent use. This standardization identifies common communication barriers and assists in resolving them in ahigh-risk environment. Acommon understanding of the inherent values, and ashared interest in learning, applying, and training these techniques are paramount in establishing aculture of patient safety. This can only be reached through excellent interprofessional teamwork and supportive leadership.

Development of a Communication Tool for Handoffs Involving Patients Cared for by Sitters: An Evidence-Based Practice Project.

Communication has been found to be central to patient safety and colleague engagement. Poor communication was identified in a Level III trauma hospital in the midwestern US between "sitters" (staff members assigned to monitor patients identified as having safety concerns) and the nurses assigned to care for those patients, including lack of a formal handoff process. A Patient/Problem, Intervention, Comparison, Outcome (PICO) statement guided an evidence-based project and identification of an intervention to improve the handoff process. Using the evidence-based format of Situation/Background/Assessment/Recommendation (SBAR), a Patient Safety Attendant Handoff Form was developed and implemented. Initially, Registered Nurses (RNs), Licensed Practical Nurses (LPNs), or Certified Nursing Assistants (CNAs) were used as sitters, taking them away from other responsibilities. A formal position, Patient Safety Attendant (PSA), was created to perform the sitter role. The Patient Safety Attendant Handoff tool was made an official hospital form and implemented as a new standard of practice. Analysis of data from completed forms identified the top reasons for assigning a sitter were mental health and behavioral concerns. In a six-month post-implementation survey, most PSAs reported receiving adequate information about the patients during handoffs using the new form. Using SBAR for the Patient Safety Attendant Handoff Form improved communication between RNs and PSAs and also enhanced communication between PSAs. A key safety feature of the form is the Recommendation section which includes "triggers to avoid," de-escalation techniques, and things the patient enjoys. Developing a structural model from the aggregated data on the completed forms helped in analyzing the information.

Practical Progress of SBAR Communication Model-Related Teaching in Clinical Teaching

This paper elaborates the core and essence of situation, background, assessment, recommendation (SBAR) communication model, clarify the application status of SBAR communication model in the clinical teaching of nursing students, and describe its effectiveness and limitations, so as to provide reference for improving clinical nursing teaching ability.

Situation, Background, Assessment, Recommendation (SBAR) Education for Health Care Students: Assessment of a Training Program.

Interprofessional communication failures are estimated to be a factor in two-thirds of serious health care-related accidents. Using a standardized communication protocol during transfer of patient information between providers improves patient safety. An interprofessional education (IPE) event for first-year health professions students was designed using the Situation, Background, Assessment, Recommendation (SBAR) tool as a structured communication framework. IPE literature, including a valid measurement tool specifically tailored for SBAR, was utilized to design the Interprofessional Team Training Day (ITTD) and evaluate learner gains in SBAR skills. Learners from six educational programs participated in ITTD, which consisted of didactics, small-group discussion, and role-play using the SBAR protocol. Individual learners were assessed using the SBAR Brief Assessment Rubric for Learner Assessment (SBAR-LA) on SBAR communication skills before and after the ITTD event. Learners received a written clinical vignette and submitted video recordings of themselves simulating the use of SBAR to communicate to another health care professional. Pre- and postrecordings were scored using the SBAR-LA rubric. Normalized gain scores were calculated to estimate the improvement attributable to ITTD. SBAR-LA scores increased for 60% of participants. For skills not demonstrated before the event, the average learner acquired 44% of those skills from ITTD. Learners demonstrated statistically significant increases for five of 10 SBAR-LA skills. The value to patient safety of utilizing structured communication between health care providers is proven; however, evaluating IPE teaching of communication skills effectiveness is challenging. Using SBAR-LA, communication skills were shown to improve following ITTD.

Development of a mobile application for emergency shift handovers using the National Early Warning Score.

To develop and validate a prototype of a mobile application shift handover between nurses in the emergency room using a severity scale. This is a technological tool carried out at the Universidade Estadual de Maringá using design thinking, divided into four phases: discovering, defining, developing, and delivering. To structure the information, a checklist was used based on the Situation Background Assessment Recommendation, and to categorize patients in terms of severity, the National Early Warning Score was used. The validation of the sample was carried out by 10 nurses, specialized in the field of urgency and emergency, using the System Usability Scale questionnaire to assess usability. The content validity coefficient was used for analysis. The application scored 75.75 in usability and had a content validity coefficient of 0.8. The prototype obtained an excellent evaluation of usability and agreement between evaluators. Future studies are needed for implementation in practice, evaluating the practicality, applicability, efficiency and time savings in shift information transfer.

The Correlation between the use of the SBAR Effective Communication Method and the Handover Implementation of Nurses on Patient Safety

Background: Patient safety is a system implemented in hospitals with the aim of providing patient comfort in the treatment process. One of the effective communication methods is using the Situation Background Assessment Recommendation (SBAR) approach, this communication method is used when nurses carry out handovers to achieve critical thinking skills and save time during the treatment process. The SBAR approach has proven to be an effective communication tool in acute and urgent patient care settings. This review aims to find effective communication methods to reduce or reduce the number of patient safety incidents, improve service quality and improve the quality of nursing care. Purpose: To find out the relationship between the use of the SBAR effective communication method and the implementation of handovers on patient safety. Methods: Using a Literature review research design with the journal search method using the Google Scholar and Elsevier databases. Results: Researchers found 13 articles that met the inclusion and exclusion criteria. The results of the literature review show that effective communication using the SBAR approach can reduce errors in communication between health workers and health workers with patients so as to prevent unwanted events. Therefore, effective communication with the SBAR approach can also improve the quality of hospital services and increase patient satisfaction and effective SBAR communication plays an important role in the implementation of handover of patient safety. Conclusion: The results of a systematic literature review show that there is a relationship between the use of the effective SBAR communication method and the implementation of handovers on patient safety and the effective communication method with the SBAR approach is expected to become a communication method that can improve service quality, reduce patient safety incidents and prevent the occurrence of unwanted events, and can affect patient satisfaction and nurse loyalty.

SBAR Method for Improving Well-Being in the Internal Medicine Unit: Quasi-Experimental Research

SBAR (Situation, Background, Assessment, Recommendation) is a tool for standardizing and improving interprofessional communication. This study aims to explore the impact of SBAR in healthcare professionals' wellbeing, through concepts such as job satisfaction, engagement, resilience, and job performance, in the internal medicine unit of a university hospital in the province of León (Spain). This is an observational, descriptive, longitudinal case study with a pre- and post-intervention approach. Questionnaires were distributed to a group of doctors, nurses, and healthcare assistants before and after the implementation of the SBAR tool in the ward. The use of SBAR was monitored to ensure staff compliance. Data statistical analysis was performed using the SPSS program. Resilience levels increased significantly post-intervention. Job satisfaction and engagement levels remained neutral, slightly decreasing post-intervention. Besides' being a useful tool to improve communication, SBAR was effective in improving resilience among staff. Several aspects related to hospital management may have had an impact on job satisfaction and engagement results.