Intervention Title:
Improving Nurse-Physician Communication Through the Situation, Background, Assessment and Recommendation (SBAR) Model – North Shore-Long Island Jewish Hospital, Great Neck, N.Y.

Goal:
Improve nurse-physician communication about a patient's situation.

Innovation:
Staff developed an assessment tool and technique that enabled easier and standardized communication about a patient's status.

Result:
The tool has enabled quicker communication between doctors and nurses, and medical/surgical teams have great appreciation for the value of communication.

Institution:
North Shore-Long Island Jewish Hospital
400 Lakeville Road
Suite 170 - Institute for Nursing
New Hyde Park, NY 11042
P: (718) 470-7000

From the experts:
“Our nurses were already articulate and well informed, but SBAR has empowered them to better assess patient situations. Responses to escalating situations are now quicker and emergency situations are dealt with faster.”

Barbara Callahan, M.S.N., A.N.P.
Director of Nursing Education and Research
North Shore-Long Island Jewish Hospital

Profile:
North Shore-Long Island Jewish Hospital is a network comprised of 15 hospitals and headquartered in Great Neck, N.Y.

Clinical areas affected:

• Medical and surgical units

Staff involved:

• Nurses
• Physicians
• Quality department

Timeline:
Staff spent two to three weeks disseminating and implementing the program.

Contact:
Kerri Scanlon
Chief Nursing Officer
P: (718) 470-7973
kscanlon@lij.edu

Innovation implementation:
SBAR, which stands for Situation, Background, Assessment and Recommendation, is a tool used exclusively to guide staff on the best way to communicate a large amount of information in a succinct and brief way when a patient's situation is escalating. It is designed to improve both the manner in which information is communicated and how it is received.

SBAR establishes a specific protocol to remind nurses what to assess and how to communicate information quickly and effectively to physicians. A nurse starts by assessing the situation and providing a concise statement of the problem that includes information such as vital signs. Background on what has happened is then provided, which may include mental status, physical changes or if the patient is on oxygen. The nurse then provides a quick assessment of what they assume the problem to be. Finally, the nurse makes a recommendation to the physician, such as coming to see the patient, making a transfer or asking if any tests are needed.

In order to establish SBAR as a standard protocol, reminders were posted throughout patient rooms. By having SBAR criteria listed in specific locations, nurses were reminded of the immediate steps to quickly determine if the patient's situation needs to be escalated to a true emergency. The structure of SBAR has enabled nurses to feel empowered as they assess patients and provide critical information to physicians.

Advice and lessons learned:

1. Use SBAR exclusively as an escalation tool. SBAR is not a tool for hand-offs or routine communication, but when there is a true escalation in a patient's condition.
2. Do not use SBAR as a reporting tool. SBAR is solely an assessment tool that facilitates staff communication; it is not meant to be a mechanism for reporting.
3. Post reminders. Since anxiety levels often rise in an emergency, post reminders about what SBAR means in patient rooms and by the phone to provide easy access.

Cost/benefit estimate:

N/A