ED Accreditation Update

SBAR techniques help EDs comply with handoff regs

A communication strategy using the SBAR (Situation, Background, Assessment, and Recommendation) template is being implemented by EDs to improve handoffs to other hospital departments, according to Deb Richey, MPA, director of emergency services at Parkview Hospital in Fort Wayne, IN.

Richey recently chaired an ED meeting about best practices in the VHA, and she quizzed the six Indiana hospitals represented about handoffs. "One thing a lot of us have done is use the SBAR template," she says. 'It works especially well when giving reports to doctors and between units."

In light of the results of the 2007 Hospital Survey on Patient Safety Culture Comparative Database Report released by the Agency for Healthcare Research and Quality (AHRQ), this attention to handoffs is appropriate and timely. (For information on how to access the survey, see the resource information at the end of this article.) Almost half (45%) of the hospital staff surveyed said there is room for improvement in the area of handoffs and transitions across units, despite the fact that 78% said there was a positive environment of teamwork within their units.

While a good deal of progress has been made in communications between units, in ongoing reports about adverse events, poor transition communication constantly shows up as an area of concern, says James B. Battles, PhD, senior service fellow for patient safety at AHRQ's Center for Quality Improvement and Patient Safety. Why is that the case? "A lot of it has to do with the 'siloed' nature of the way we communicate," Battles explains. "Part of the solution is to get people to begin to think of their unit as part of a system — not just the ED or the ICU — because the connections that flow upstream and downstream are critically important."

Richey says, "The [VHA] attendees all seemed in agreement about this issue, and a lot of hospitals are currently working on how to improve communications between units."

Battles agrees that SBAR is a valuable tool that EDs should consider using. "Communications approaches such as SBAR have shown to be extremely important as we cross [departmental] barriers," he says. AHRQ and the Department of Defense are working to create a standardized approach to team training, and Battles says their research has shown that "you can use structured and standardized communication sets like SBAR to really improve things."

How SBAR works

Richey explains each of the four components of SBAR:

  • Situation: Details of the patient's current situation.
  • Background: Any historical information that is relevant to the injury or illness that has occurred.
  • Assessment: The current clinical condition.
  • Recommendation: Orders concerning what needs to be done, test results to watch for, or items about which the doctor should be called.

"The template we look at when we teach the staff how to communicate this way looks like a grid," Richey explains. [Editor's note: Click here for a copy of a sample SBAR form.]

"It is helpful because the person who is listening [to the individual handing off] kind of knows what to expect in terms of that communication," Richey says. They know, for example, not to look for recommendations in the first four or five sentences, "but they also know they will get to it eventually," she says.

At Richey's facility, educational sessions several hours in length were held to train the facility's education team on SBAR and communication techniques. Subsequently, they put the ED staff in a classroom with the education team, which then taught them the SBAR techniques.

"They used both didactic instruction as well as team-building exercises to teach SBAR," she says. This education program started with the critical care staff and eventually will be expanded to other hospital departments, says Richey.

Teaching your staff about SBAR is just the first step, Richey emphasizes. You've got to be sure the technique is fully implemented by your staff. "We conduct additional [random] auditing to make sure it is really hardwired into the organization and that it is being used consistently," she says.

SBAR is not the only strategy being used to improve handoffs at Parkview, she says. "Another approach that we have trialed is to do face-to-face or bedside reports, especially in the critical care environment," she says. "This way the two nurses are looking at the same things at the same time and, when appropriate, they can also involve the patient in the handoff."


To download a free copy of "Hospital Survey on Patient Safety Culture: 2007 Comparative Database Report," go to AHRQ's Patient Safety E-Newsletter at www.ahrq.gov/qual/hospsurveydb.