The acronym ISBAR describes a structured approach to clinical handover
which is clear and concise, identifies those involved, specifies timeframes
and assigns/accepts accountability and responsibility. It was originally
'SBAR' in the military nuclear submarine industry, spread to aviation and
finally health care; with an "I" added to remind people to appropriate
identify each other. NETS has added an 'L' to the acronym to stress the
importance of listening (for the 'receiver' of the communication) and the
need for the 'sender' of the information to verify that.
L = Listen
I = Identify
S = Situation
B = Background
A = Assessment
R = Recommendation
For medical retrieval; there are some special requirements as handover is
often done by telephone between people who don't know each other.
What is the clinical background or context? Provide the current history,
examination findings and relevant pathology and imaging results. State the
patient's name, date of birth and body weight. Provide the time of injury
or commencement of symptoms and the time of triage. For newborns, provide
the time of birth.
What is your patient's clinical status and support level? What do you
think the current problems are which you'd like discussed? Have the
patient's current vital signs and support settings (FiO2, ventilatory
support, fluids, drugs) available.
What is your plan of treatment? What are you asking for from NETS and
expert clinicians brought into the NETS' conference call? What is the
shared plan of treatment - now and pending a transfer or retrieval?
What do you want from the person you are calling? Be clear about what you
are asking and the timeframes. Repeat to confirm what you have heard;
including any management plan details.
This tool started life in the nuclear industry as 'SBAR'. Having had the
'I' added in health care, we've added an 'L' to the tool.
L = Listen
Communication is ineffective unless it is accurately and completely heard
by the listener. A common problem with handover in the medical retrieval
context is while information may be clearly stated, it is sometimes not
heard. Active listening is required; without distractions. Ensure that you
give the caller your full attention and seek to avoid surrounding noise and
activity which might interfer with your ability to listen effectively.