Urgent Oral Communication
last authored: July 2012, David LaPierre
last reviewed: Nov 2014, Leanne Crawford
Introduction
There are many circumstances where a health care provider will realize the clinical situation they are facing exceeds their capacity, and the appropriate next step is to call for immediate help.
Whether by phone or in person, it is important to have gathered the information your colleague or supervisor will want, to organize it in a simple fashion, and to clearly communicate it.
The following tool is a suggestion for providing clearly organized communication.
SBAR
SBAR (normally pronounced 'es-bar') is a communication tool primarily used to guide nursing communication with physicians, though it may also be used for physician-to-physican communication or reports between any number of health care providers.
Situation
Identify yourself.
Provide the patients name, age, and gender.
Briefly describe the history, vital signs, and appropriate focused physical exam. Including pertinent positives and negatives, where you deem it to be important. As warranted, results of recent investigations (lab work or imaging) may be provided.
Background
Again, speaking briefly, describe how long the patient has been admitted, and what the admitting diagnosis is (as appropriate). Mention any medical conditions or medications you think may be important. Also, provide information about how the patient's course has been in recent hours or days.
Assessment
Provide a summary of the situation, focusing particularly on why you are concerned. As you see fit, you may decide to mention diagnoses you think could be occurring.
Recommendation
Provide a clear request to the listener. Often you will be wanting them to come assess the patient themselves, and it is important to ask this. Alternatively, you may mention that you wanted the listener to be aware, and that you recommend ongoing monitoring. You may also suggest initial investigations or treatments you believe could benefit the patient.
Once receiving their response, repeat back their instructions to them, so that you demonstrate (to them and to you) that your understanding is clear.
Example
S Hello, Dr West, this is Jane Allen, fourth year medical student, calling from the medicine floor.
I just saw Alice Timmons, a 64 year old woman, and I'm concerned about her.
She developed shortness of breath about an hour ago, and it's worsening to the point that she is having trouble talking. She doesn't have any cough, chest pain, or fever, and isn't complaining of anything else.
She's alert, but looks distressed and a bit pale. Her vitals show a HR of 102, BP of 122/88, RR of 28, temp of 37.2, and initial sats of 84%. We put oxygen on at 4L, and now her sats are up to 90%.
She has crackles in both lung fields when I listen. Her JVP also looks elevated to me. She has no edema.
B Regarding background, she's a healthy lady who was admitted today with a bad cellulitis. We started IV antibiotics. She was a dehydrated as well, and we rehydrated her with 2L of normal saline.
A I don't like how she looks. I wonder if we put her into heart failure with the IV fluids. I suppose she could also have a pulmonary embolus, or maybe an MI? I don't think this looks like pneumonia.
R Could you come and see her and let me know what you think? In the meantime, I am wondering about getting a chest X-ray, ECG, and some bloodwork, as well as starting some furosemide to help with the possible failure...
Resources and References
 |