SBAR handover explained: a structure, a worked example and the traps in exam questions

What SBAR is and where it came from

SBAR is a structured communication tool. The Institute for Healthcare Improvement describes it as a technique that was adapted for health care from the United States Navy, and credits clinicians at Kaiser Permanente in Colorado with developing the healthcare version. A paper by Haig, Sutton and Whittington (2006) described it as a shared mental model for improving communication between clinicians.

The idea is simple. People under pressure ramble, leave out the key point or bury it. A fixed order makes you lead with what matters and makes the listener’s job easier.

This is exam-preparation revision, not clinical guidance. In practice, follow your own organisation’s policies and current guidelines.

The four parts

Each letter has a job.

• Situation: who you are, where you are, who the patient is and the problem right now, in one or two sentences.
• Background: only the history that helps the listener decide, such as the reason for admission, relevant procedures, allergies, current treatment and recent trends in observations.
• Assessment: what you think is going on and how serious it is. Include the latest vital signs and any early warning score your organisation uses.
• Recommendation: what you want. A review within a stated time, a test, a change in treatment, a plan for monitoring. Ask for read-back or a clear plan.

A worked example

This script is invented for teaching. A nurse calls the doctor on call.

Situation: “I am a nurse on the surgical ward. I am calling about a patient in bed 12, a man in his sixties. In the last hour his blood pressure has fallen to 88 over 50 and his heart rate has risen to 118.”

Background: “He is on day one after a bowel resection. He has a drain, and his pain is controlled with an infusion. His blood pressure this morning was 125 over 75.”

Assessment: “He looks pale and clammy and his urine output has dropped. I am worried that he is bleeding or becoming septic. I think he is unwell and getting worse.”

Recommendation: “Please can you review him within the next ten minutes. Do you want me to start fluids and send blood tests? I will repeat his observations every 15 minutes until you arrive.”

How exam questions test it

Communication questions usually give you several versions of a message and ask which is best. The strong option is brief, puts the current problem first, includes the latest numbers, and ends with a specific request. The weak ones start with a long history, hide the reason for the call, use vague words such as “not doing well” or end without asking for anything.

Another common version asks what you should do before calling: have the chart, the latest observations and the medication list to hand, and know the patient’s code status if relevant.

Common traps

Watch for these.

• Starting with Background. The listener does not yet know why you are calling.
• Giving an assessment without data. “He looks bad” should come with numbers.
• Leaving out a recommendation. Always say what you want and by when.
• Not escalating. If the first person cannot help or does not respond to a worrying patient, follow your chain of command and escalation policy.
• Forgetting to document the call, the time and what was agreed.

SBAR at shift handover

At handover, the same order works, with a bit more detail in Background and a plan under Recommendation: what is due, what to watch for and who to call. A handover is also a safety check, so use identifiers, check allergies and note outstanding results. Taking handover at the bedside, where policy allows, lets you verify lines, infusions and the patient’s own understanding.

Variants you may meet: SBAR-R, ISBAR and I-PASS

Some organisations adapt SBAR. ISBAR adds an Identify step at the start, so the speaker names themselves and the patient clearly. Some versions add a read-back at the end, to check that the listener has understood. The I-PASS handover bundle, studied in a large paediatric study published in the New England Journal of Medicine in 2014, uses a different structure: illness severity, patient summary, action list, situation awareness and contingency planning, and synthesis by the receiver. You do not need to memorise every variant, but know that they share the same aims: lead with the key problem, be brief and check understanding.

A second example: a medication concern

This invented example shows SBAR for a pharmacist call. Situation: “I am the ward nurse calling about a patient in bed 4. The prescription for her insulin has a dose written as ‘10 U’, and I am not sure whether it is 10 or 100 units.” Background: “She has type 2 diabetes and her glucose this morning was 12 millimoles per litre. She has not had insulin yet today.” Assessment: “The abbreviation is ambiguous, and I think there is a risk of a dosing error.” Recommendation: “Please can you confirm the intended dose and rewrite the order using the word ‘units’. I will hold the dose until I hear from you.”

Barriers to good SBAR in real life

In practice, people avoid escalation because of hierarchy, fear of being wrong or worry about disturbing a colleague. Exams reflect this by testing whether you escalate when you should. If a patient is deteriorating, calling is never wrong. If the first call does not get a response, use the escalation route your organisation provides. Keep your language specific and use numbers. Phrases such as “I am worried because” signal urgency without being dramatic.

Teaching and checking your own SBAR

A good way to practise is to record yourself giving an invented SBAR on your phone, play it back and listen for three things: did the first sentence say why you were calling, did you give numbers rather than adjectives, and did you finish with a clear request? Aim for under 60 seconds. Then try it with a colleague who plays the doctor and interrupts with a question. The interruption is the realistic part, because real calls rarely run as scripted.

If you are a senior colleague, notice how juniors present and give feedback on structure, not only on content. A habit of clear escalation is one of the more useful things a team can build, and it is exactly what exam questions on communication are checking.

Documentation after the call

After an escalation, document the time of the call, who you spoke to, what you reported, what was advised and what you did. Include the observations that prompted the call. If a response is delayed or inadequate, document that too and escalate further according to your policy. Questions about documentation usually reward factual, timely, signed entries and penalise vague or late ones.

Practising

Practise by saying SBAR aloud for real or invented cases. Time yourself: aim for under a minute. Meddex includes scenario questions in the question bank, and you can add SBAR to your flashcards as a card that asks for the four parts. The post on mnemonics lists other tools to learn alongside it, and the DHA exam for nurses page shows how communication fits into the exam.

Frequently asked questions