Communication over the
phone & handover
Effective communication is very important.
• From 1995 – 2005 JCAHO reviewed over 2537 sentinel events in
General Hospitals and Emergency Departments
• Communication issues identified as being the root cause and the
major contributor in these events
• In 2005 nearly 70% of sentinel events, the root cause was
communication.
Why does communication break down?
• Different communication styles
• High level of activity
• Frequent interruptions
• No standardization in organizing essential information
What Can Go Wrong?
• CONCERN was communicated – BUT:
• PROBLEM:
was not clearly stated
• PROPOSED ACTION: didn’t happen
• DECISION: was not reached
What is SBAR?
• The SBAR model is a simple method to help standardize
communication
• SBAR allows all parties to have common expectations:
• What is going to be communicated
• How the communication is structured
• Required elements
• Focuses on the problem, not the people
So What is SBAR?
• Situation: Give a brief introduction, the punch line (5-10 seconds)
of what you are calling about.
• Background: Give data relevant to the problem including history
and clinical findings.
• Assessment: State what you think the problem is but give an
indication of severity
• Recommendation: What do you think need to be done for this
patient and if appropriate get an estimated time frame for a
response.
SITUATION
• State: your name and unit
• I am calling about:: (Patient Name & bed number)
• The problem: The reason I am calling …..
Situation (Scenario 1)
• “Good evening sir. This is Dr. XYZ, a Resident doctor on duty, I just
saw Mr. ABC on bed no 9 in the ward. I am contacting you because
Mr. ABC is complaining of severe abdominal pain”.
Background
• Information about the patient that the doctor needs to know that will
help in identifying the source of the problem as well as its potential
solution.
• This includes medical history and clinical findings.
Background (Scenario1)
• “He got admitted to the hospital five days ago with appendicitis and
you had done appendicectomy on him three days back.”
Assessment
• The assessment is when the doctor recalls what was observed when
checking the patient.
• This includes the information gathered during the physical
examination.
• The most common information that is obtained from patients are
their vital signs: blood pressure, heart rate, temperature and
respiratory rate.
Assessment (Scenario1)
• “I found him the bed groaning with his hand on his abdomen. He
states the pain is worse today even after taking the pain medication
you already ordered. His temperature is raised and incision site looks
good, but his blood pressure is reduced and he is tachycardic and
tachypnoeic. His saturation is 85% on air. I think he needs intensive
care monitoring”
RECOMMENDATION
• State what you would like to see done:
•
•
•
•
Transfer the patient?
Change treatment?
Come to see the patient at this time?
Talk to the family and patient about….?
Recommendation (Scenario1)
• Could you please come to see him now?
• Do you want me to get US abdomen done?
• How long it will take for you to come down to see this patient?”
Scenario 2
• You have seen 58 yr old patient with chest pain. He has family history
of heart disease. He is diabetic and hypertensive. Before coming to
the hospital he has seen the GP for this chest pain and has been given
antacids.
• On examination his HR is 118/min regular but only carotid and
femoral pulses are palpable. He has cold peripheries and his BP is
75/50mmHg. JVP 3 cm. HS are normal and chest is clear. Pulse
oximetry is not picking up signal. On examination of abdomen he has
mild splenomegaly but no jaundice. He has no palpable Urinary
bladder and he says he has not passed urine for the past 16 hours.
• You are consulting your Senior ….
Scenario 2 - SBAR
• Situation: 58 yr old with severe shock
• Background: Cardiovascular risk factors for IHD. Currently had angina
type chest pain. BP 75/50, HR 118/min, JVP 3cm, cold peripheries.
• Assessment: Severe cardiogenic shock
• Recommendation: Please can you come to see him immediately.
Would you like me to prepare for any inotropic infusion while you are
coming? How soon can I expect to see you?
Handover
• Transfer of responsibility from one care giver to other.
• Goal is to provide timely, accurate information about
•
•
•
•
a patient's care plan,
treatment,
current condition and
any recent or anticipated changes.
• Handover is a crucial communication, if carried out poorly can
obviously compromises patients safety.
Handover
• Handover in ICU during shift change
• Hand over on the phone of particular patient
Tools to assist handover
• Forms and checklists
• Five P’s
•
•
•
•
•
Patient: Name, Identifiers, Age, Sex, Location
Plan: Patient Diagnosis, treatment plan, next steps
Purpose: Provide a rationale for the care plan
Problems: Explain what's different or unusual about this specific patient
Precautions: Explain what's expected to be different or unusual about the
patient
Tools to assist handover
• Forms and checklists
Tools to assist handover
• Forms and checklists
Handover in ICU
Tools to assist handover
• Background clinical information
• ‘ He is 60 yr old pt,
known to have
COPD and HT’
Tools to assist handover
• Course of acute illness
‘He has septic shock from
perforated ischemic bowel and
developed acute kidney injury.
He has been extubated for the
past 24 hours, off antibiotics and
is on intermittent haemodialysis’
Tools to assist handover
• To do list
‘He needs to have a new
haemodialysis
catheter inserted tonight as
existing one is having
inadequate flow’
Tools to assist handover
• Anticipation of events
‘In case his blood pressure drops
again, I’d escalate antibiotics
and ask for CT scan of the
abdomen’
Handover of a patient on the phone
Tools to assist handover
• I PASS THE BATON: This technique is designed to assist with both
simple and complex handoffs.
• I : Introduction - Individuals involved in the handoff identify themselves, their
roles and jobs
• P : Patient - Name, Identifiers, Age, Sex, Location
• A : Assessment - Present chief complaint, vital signs, symptoms and diagnosis
• S : Situation - Current status, response to treatment
• S : Safety concerns - Critical lab values and reports, socioeconomic factors,
allergies
• B : Background - Previous episodes, Current medications, and family history
• A : Actions - Details about what actions were taken and/or are required
• T : Timing - Level of urgency and explicit timing
• O : Ownership - Who is responsible?
• N : Next - What will happen next? Plan of action
Introduction
Hi I’m Dr. XYZ. I am the
registrar on call. I would like
to handover a patient to you
Patient
He is 60 year old man called
ABC, hospital no 11111, in
ward B
Assessment
His main problem is AKI due
to obstructive uropathy. He is
anuric. He is a bit tachypnoeic
and tachycardic HR 100/min.
BP is normal
Status
He has just received dialysis
for fluid overload and
hyperkalaemia. He is not
acidaemic.
Safety Concerns
We are mainly now
concerned about his fluid
overload causing breathing
difficulty and hyperkalemia.
There are no other safety
concerns at present
Background
He has no relevant past
medical history. He is allergic
to Quinolones
Action
I have just asked for chest xray and sent blood for urgent
potassium. Can you please
check it?
Timing
…..which should be available
in next 30 min.
Ownership
If there is a problem his
consultant is Dr. xxxx He is
looking after this patient
Next
If the X ray is still showing
signs of fluid overload and
potassium is still high, he
may need more dialysis.
Key points
• Handover is a crucial communication
• Written notes should be used to supplement a verbal handover
• Do not overwhelm the recipient with irrelevant information
• Use a system to avoid omitting something vital.
•Thanks!