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Voice mail, e-mail, text messaging, faxing, and paging: despite the plethora of means available, concise and accurate communication remains an elusive goal. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), communication errors are the root cause of almost 70% of sentinel events, and 75% of the patients involved died (Leonard, Graham, Sc Bonacum, 2004). Both JCAHO and the Institute for Healthcare Improvement (IHI) are espousing the use of a communication tool known as Situation, Background, Assessment, and Recommendation (SBAR). Unfortunately, even a cursory literature review reveals not only the massive scope of health care's communication problem, but also the lack of evidence supporting the use of SBAR. The IHI maintains an SBAR discussion group where professionals seek information about how to implement and measure its effectiveness (Institute for Healthcare Improvement [IHI], 2006). Should SBAR be taught as a format to facilitate oral communication, or should nurses be required to complete forms with every phone call? Does SBAR improve communication, or are improvements secondary to other factors? What outcomes should be measured and how? Prior to implementing an institution-wide training program on the use of SBAR to facilitate nurse-physician telephone communication, a pilot study was conducted in an attempt to identify problems before money and time were invested. Although the study did not produce statistically significant data supporting the use of SBAR, it did smooth the implementation process.
The SBAR Model
A Shared Format for Communication
SBAR is a communication format which was initially developed by the military and refined by the aviation industry to reduce the risks associated with the transmission of inaccurate and incomplete information. As previously mentioned, the acronym SBAR stands for Situation, Background, Assessment, and Recommendation. In other words, the person doing the communicating starts by stating what is happening right now, moves on to the context, provides a problem assessment, and suggests a solution. Some organizations add an additional R (SBARR) in which the listener "repeats back" what he or she has heard. This simple format, which mirrors the scientific and nursing process, can be used to organize both verbal and written communication. Although the format remains the same, content may be situation specific.
Dr. Michael Leonard of Kaiser Permanente, Colorado, has done extensive work with the SBAR...