SBAR (Situation – Background – Assessment – Recommendation)
An effective and efficient way to communicate important information.
During the 2015 Association of Organ Procurement Organizations (AOPO) Tri-Council meeting, I had the opportunity to attend a presentation given by Dr. Nicole Neidlinger, kidney transplant surgeon and Medical Director for Donor Network West (formerly California Transplant Donor Network). Dr. Neidlinger spoke about SBAR (Situation – Background – Assessment – Recommendation), which is a model of communication commonly used in healthcare today. I was so inspired that I brought it back to my department and shared with my staff.
SBAR was originally developed by the U.S. Navy as a communication technique that could be used on nuclear submarines. In the late 1990s, Safer Healthcare, an organization that focuses on the delivery of specialized products and services supporting the development and sustainability of high reliability organizations (HRO) within the healthcare industry, helped bring this communication model into the healthcare setting. Since that time, SBAR has been adopted by hospitals and care facilities around the world as a simple yet effective way to standardize communication between care givers.
To bring context to SBAR, users should consider the following framework:
Situation Take 5-10 Seconds to Explain
Background Provide Context and Data
Assessment Describe the Specific Problem/Situation
Recommendation Explain What You Want to Do About it and When
If you’re asking yourself, “Why SBAR?” I offer the following:
- It’s the Joint Commission’s stated industry best practice for standardized communication (primarily spoken) in healthcare for effortlessly structuring critical information;
- It promotes quality, patient safety and high reliability because it helps individuals communicate with each other with a shared set of expectations;
- Staff and physicians use SBAR to share patient information in a clear, complete, concise and structured format, improving communication efficiency and accuracy.
How Does SBAR Translate to Organ Procurement Organization (OPO) Professionals?
It can be used in a “Team Huddle” scenario (spoken by the OPO Transplant Coordinator).
|Situation||“The patient has satisfied death by neurologic criteria and has been pronounced dead by Dr. Smith. The patient is medically suitable to donate organs and tissues.”|
|Background||“This patient was a victim of an MVC. Upon meeting clinical triggers, Sue, the bedside RN, referred this patient as a potential donor. The family has now gathered at the bedside to say their good-byes.”|
|Assessment||“Since it appears that the family understands their loved one has died, we now need to formulate a plan for providing the family with their donation opportunity.”|
|Recommendation||“I suggest that we determine which member of the care team has established a trusting relationship with the family and encourage him or her to introduce me and remain present to support the family during the donation conversation. How does this sound?”|
It can be used in a Physician Meeting (spoken by the OPO Hospital Development Coordinator).
|Situation||“We were called to evaluate one of your patients last week as a potential organ donor. The patient’s heart, lungs, liver and kidneys were all successfully transplanted. I wanted to thank you for all that you did to help make this happen.”|
|Background||“It sounds like the family initially really struggled to understand that their loved one had died. Two of your residents spent an extensive amount of time with them.”|
|Assessment||“After talking with your residents about their experience, I think that they are uncomfortable talking to families about death by neurologic criteria.”|
|Recommendation||“I’d like to provide all of your residents with training on how to explain death by neurologic criteria to families. We can customize it to meet whatever time constraints may exist. What do you think?”|
When the organ donation process goes well, it is usually due to collaboration and communication. Similarly, when it doesn’t go well, it’s largely due to breakdowns in these two areas. In hospitals and critical care areas in particular, optimizing our communication is essential. Getting and keeping members of the care team engaged also requires us to evaluate how we are communicating.
- Can we say more with less?
- Are you receiving non-verbal indicators that the listener is busy, disinterested, or in a rush?
- Are you listening for short answers like “yes” or “no” that are potential signs that you provide “Just the Facts Jack”?
- Is the person that you’re attempting to engage asking questions in return?
- Do they seem curious?
- Do they actually sit down to talk with you?
If they appear to have time for a more lengthy conversation then, by all means, take full advantage of that and enjoy the interaction! If they’re not, SBAR is probably the way to go. I strongly recommend that you incorporate this communication model into your approach just once and see how it works.
For additional SBAR information and resources, please visit:
Gweneth D. O’Shaughnessy is Director of Hospital Services at Gift of Life Donor Program in Philadelphia, PA