SBAR turns "something's wrong" into a request someone can act on.

01 / Background

Why structure matters.

SBAR stands for Situation, Background, Assessment, Recommendation (or Request). It was adopted as a communication standard at Kaiser Permanente and shared more widely through the Institute for Healthcare Improvement. AHRQ's TeamSTEPPS program teaches it as a core team communication tool. Its value is predictability: the listener knows where the important information will be, and you know you haven't left out the ask.

02 / The framework

SBAR and ISBARR, part by part.

Many nursing programs teach ISBARR, which adds an Introduction at the start and a Repeat-back at the end. Open RN's Nursing Fundamentals describes each part this way:

I / Introduce

Your name, role, and unit.

S / Situation

The patient's name and location, why you're calling, recent vital signs, and the patient's status.

B / Background

Pertinent context: admitting diagnosis, code status, relevant recent labs or tests, and allergies.

A / Assessment

Your abnormal findings and your evaluation of what's going on.

R / Request

What you want the provider to do: come and assess, order a test, change a medication or treatment.

R / Repeat back

Read back any new orders to confirm them before you hang up.

03 / Preparation

Prepare before you pick up the phone.

• Assess the patient yourself first, and get a fresh set of vital signs.
• Have the chart open: admitting diagnosis, recent vital sign trend, recent labs, current medications and allergies, and code status.
• Know the trend, not just the latest number. "90%, down from 93% at 0400" is far more useful than "90%."
• Decide your request before you dial. If you can't name one, say what you're worried about and ask the provider to come and evaluate.
• Have something to write with for orders and the read-back.

04 / Worked example

Calling the provider about Mr. D.

Mr. D. is the fictional 72-year-old with community-acquired pneumonia from our head-to-toe assessment and SOAP note guides. At 0820 on day 2, his oxygen saturation is lower than it was overnight and his urine output is low. Here's the call:

I

"This is Sam, the nurse caring for Mr. D. on 4 West."

S

"I'm calling about Mr. D. in room 412. His oxygen saturation is 90% on 2 liters, down from 93% at 0400, and he's put out only 200 mL of urine since midnight. Temp 38.4, heart rate 104, respirations 24, blood pressure 128/76."

B

"He's 72, admitted yesterday with right lower lobe community-acquired pneumonia, on IV antibiotics. He's a full code, and he's allergic to penicillin."

A

"He has crackles and diminished sounds at the right base, a productive cough, and pleuritic pain at 4 out of 10. He's alert and oriented. He ate very little last night and his mucous membranes are dry. I'm concerned his oxygenation is worsening and that he's getting dehydrated."

R

"I'd like you to come and evaluate him this morning. In the meantime, would you like to change his oxygen or start IV fluids?"

R

Read back each new order word for word, confirm it with the provider, and document the call, the orders, and the time.

Notice the S. The provider hears the reason for the call in the first sentence, with the trend attached. The background is limited to what's relevant to this problem; Mr. D.'s full history can wait. The assessment includes the nurse's interpretation ("I'm concerned his oxygenation is worsening"), which is exactly what the provider needs from the person at the bedside.

05 / Shift change

Bedside handoff uses the same skeleton.

At shift change, many hospitals do handoff face to face at the bedside, with the patient included. It follows the SBAR structure but adds what the next nurse needs to keep the plan going: current head-to-toe findings, lines, drains and devices, and recent changes in medications, labs, tests, and treatments.

Then check the room together: oxygen device and flow rate, IV site and infusion, bed low with the call light in reach. The patient can correct or add to the report, which is one reason bedside handoff exists.

06 / Common errors

Mistakes that derail a call.

• Leading with background. If the reason for the call comes two minutes in, the listener has stopped listening.
• Numbers without trends. One value rarely tells the story. Give the previous value and the time.
• No assessment. Saying what you think it means is part of your role. "I'm worried he's getting worse" is a legitimate, useful assessment.
• No request. End with a clear ask, even if it's "please come and see him."
• Skipping the read-back. Verbal orders are an error risk. Repeat back and confirm every one.
• Not escalating when you're unsatisfied. If you still believe the patient is unsafe after the call, follow your facility's chain of command.

Keep going with Mr. D.

The call is one part of the record.