SBAR Tool: Situation-Background-Assessment-Recommendation

​​​​​​​​Institute for Healthcare Improvement
Cambridge, Massachusetts, USA

The SBAR (Situation-Background-Assessment-Recommendation) technique provides a framework for communication between members of the health care team about a patient's condition.

  • S = Situation (a concise statement of the problem)
  • B = Background (pertinent and brief information related to the situation)
  • A = Assessment (analysis and considerations of options — what you found/think)
  • R = Recommendation (action requested/recommended — what you want)

SBAR is an easy-to-remember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety.

Michael Leonard, MD, Physician Leader for Patient Safety, along with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente of Colorado (Evergreen, Colorado, USA) developed this technique. The SBAR technique has been implemented widely at health systems such as Kaiser Permanente.

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This tool has two components:

  • SBAR Guidelines (“Guidelines for Communicating with Physicians Using the SBAR Process”): Explains in detail how to implement the SBAR technique
  • SBAR Worksheet (“SBAR report to physician about a critical situation”): A worksheet/script that a provider can use to organize information in preparation for communicating with a physician about a critically ill patient
Both the worksheet and the guidelines use the physician team member as the example; however, they can be adapted for use with all other health professionals.
Related Literature
  1. Spath PL (ed). Error Reduction in Health Care: A Systems Approach to Improving Patient Safety. San Francisco, California, USA: Jossey-Bass; 2000.
  2. Wiener EL, Kanki BG, Helmreich RL. Cockpit Resource Management. San Diego, California, USA: Harcourt Brace; 1993.
  3. Cook RI, Woods DD. Adapting to new technology in the operating room. Human Factors. 1996;38(4):593-613.
  4. de Leval MR. Human factors and surgical outcomes: A Cartesian dream. Lancet. 1997;349(9053):723-725.
  5. de Leval MR, Carthey J, Wright DJ, Farewell VT, Reason JT. Human factors and cardiac surgery: A multicenter study. Journal of Thoracic and Cardiovascular Surgery. 2000;119(4 Pt 1):661-672.
  6. Frank JR, Langer B. Collaboration, communication, management, and advocacy: Teaching surgeons new skills through the CanMEDS Project. World Journal of Surgery. 2003;27(8):972-978.
  7. Helmreich RL, Merritt AC. Culture at Work in Aviation and Medicine: National, Organizational and Professional Influences. Aldershot, Great Britain: Ashgate, 2001.
  8. Helmreich RL. On error management: Lessons from aviation. British Medical Journal. 2000;320(7237):781-785.
  9. Kosnik LK. The new paradigm of crew resource management: Just what is needed to re-engage the stalled collaborative movement? Joint Commission Journal on Quality Improvement. 2002;28(5):235-241.
  10. Sherwood G, Thomas E, Bennett DS, Lewis P. A teamwork model to promote patient safety in critical care. Critical Care Nursing Clinics of North America. 2002;14(4):333-340.
  11. Young GJ, Charns MP, Daley J, Forbes MG, Henderson W, Khuri SF. Best practices for managing surgical services: The role of coordination. Health Care Management Review. 1997;22(4):72-81.
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