We need to talk about SBAR

 You can’t have a discussion about communication without stumbling over the mnemonic SBAR. Transplanted from the US Navy, it is the most common handover tool mentioned in the secondary care debriefs I’m involved with. 

From “Online library of Quality, Service Improvement and Redesign tools” 

There are benefits to using some sort of mnemonic that all parties involved in a communication are familiar with. It reduces unnecessary questions, structures the information and suggests a minimum dataset that the caller should be able to relay.

There are significant downsides to SBAR.

First, nobody actually uses it (or if they do, they don’t use it in simulation). Everybody talks about it, everybody refers to it, people say that’s what they use, but they don’t. People use RAB, ABR, ABS and all sorts of other methods for conveying information.

Second, it’s not what the receiver wants to hear. In particular, the receiver does not want to wait however many minutes it takes to get to the R. The receiver wants to hear the R up front because then they know if they need to get out of bed, get someone else to take over the patient they’re dealing with, sit back to listen to the rest of the story to provide advice, etc.

Third, the SBAR does not confirm accurate receipt of the information. (In the picture above this is suggested at the bottom of the SBAR tool).

Fourth, the SBAR has become so engrained within healthcare that it will be difficult replace it even though it is a poor cognitive aid. 

There is a better mnemonic, it is called ISOBAR. 

From Porteous et al. “ iSoBAR — a concept and handover checklist: 

the National Clinical Handover Initiative”

ISOBAR includes identifying yourself and the patient, and a read back at the end. (The A has been changed from Assessment to Agreed Plan.) Now, if we just make it that little bit better by adding another R (for “Reason for calling” perhaps) and taking away the B, we would get IRSOAR (eye-arr-soar). 

It’s not quite as catchy as SBAR. It just about squeezes in to the “magic number 7” rule. But if it could overcome those barriers it would be a tool that might actually be used and useful.