Quality of the Situation‐Background‐Assessment‐Recommendation tool during nurse‐physician calls in the ICU: An observational study

Abstract

Background: Situation-Background-Assessment-Recommendation (SBAR) is a tool for structuring communication between healthcare professionals. SBAR reduces medical errors, however few studies have evaluated its quality in real practice. Aims:To describe the quality of SBAR utilization by intensive care unit (ICU) nurses during phone conversations with physicians. To assess the influence of nurses' training, professional experience, and call circumstances on this quality.Study Design: This observational study was conducted in the adult ICU of a university hospital in French speaking Switzerland. All consecutive telephone calls from nurses to physicians during a calendar month, were recorded. Those related to a change in patients' clinical status were selected and analysed. The quality of SBAR utilization was assessed using a pre-defined analysis grid. Scores ranged from 0 (worst quality) to 100% (best quality). Nurses' sociodemographics and training record were collected. Multiple regression was used to assess determinants of SBAR quality including nurses characteristics and level of training.Results: We analysed 290 phone calls, made by 99 nurses. The median SBAR quality score was 41% (interquartile range [IQR] 33-48). Quality scores varied across the four items of SBAR: Situation 88% (81-94), Background 17% (6-27), Assessment 17% (0-33), and Recommendation 33% (17-40). Factors independently associated with higher SBAR quality were age (À0.66%, p = .002, 95% CI [À1.07; À0.25]), primary language other than French (À8.40%, p = .017, 95% CI [À15.29; À1.51]), lack of ICU expertise (À9.25%, p = .013, 95% CI [À16.5;1-1.99]), and SBAR training in pre-graduate nursing education (+11.53%, p = .028, 95% CI [1.27; 22.79]). Conclusions: The quality of SBAR utilization remains low in ICU clinical practice. Preand post-graduate training seem to improve its quality. Relevance to Clinical Practice: Pre-graduate mandatory training associated with multiple repetitions could improve nurses' SBAR utilization. Training using the SBAR tool should be combined with the development of nursing skills in assessment and clinical judgment.

The Use of the Situation, Background, Assessment, and Recommendation (SBAR) Form as a Tool for Handoff Communication in the Pediatrics Department in a Sudanese Teaching Hospital

“…Regarding items in the "Background" component, there was also a noticeable improvement following the intervention, which was also noted in a study conducted by Achrekar et al [9]. However, a lower percentage of adherence to this component was reported by Scolari et al [13]. The "Assessment" component of the SBAR form displayed the lowest percentage of improvement in this study and a similar conclusion was reported by Scolari et al [13].…”

“…Healthcare professionals' view of the importance of the SBAR tool is highly crucial, as it directly affects their adherence to uitilizing this tool for proper patient handoff. Overall, doctors displayed a positive attitude regarding their perception of SBAR form implementation, a finding similar to previous literature reports [ 13 , 17 - 18 ]. However, a notable proportion of doctors raised issues regarding time constraints in filling the SBAR form; these issues were also reported in previous studies conducted among nurses [ 13 , 19 ], which warrants a review of the simplicity of the SBAR form structure, additionally as a number of doctors also revealed difficulty understanding the content of the SBAR form.…”

“…Items in the “Situation” component were poorly documented in pre-existing practices, however, a pronounced improvement was observed following the intervention. Other previous similar studies conducted by Scolari et al [ 13 ] and Achrekar et al, among nursing professionals also reflected similar results with regard to the “Situation” components [ 9 ]. Regarding items in the "Background" component, there was also a noticeable improvement following the intervention, which was also noted in a study conducted by Achrekar et al [ 9 ].…”

“…However, a lower percentage of adherence to this component was reported by Scolari et al [13]. The "Assessment" component of the SBAR form displayed the lowest percentage of improvement in this study and a similar conclusion was reported by Scolari et al [13]. Achrekar et al reported a small difference in improvement within this component; however, this could be explained by the initial good practice observed in his study regarding this component [9].…”

Spotlight on literature reviews

“…The other papers in this issue employ a range of methodologies to address various clinically relevant topics, namely delirium in critically ill adults 10 and children 11 ; nurse–nurse 12 and nurse‐doctor collaboration 13 and teamwork 14 ; sleep quality 15,16 ; sedation and pressure injuries 17 and ABCDE bundle implementation 18 …”