Patient Hand-Off Tool for Patient Safety

Abstract

SBAR is a postoperative tool that helps compress the complex work done by medical practitioners and ease the communication network by minimizing interruption and providing a support framework. SBAR tool is an abbreviation for; S: situation, B: background, a: assessment), and acts as an enabler of patient safety as it improves communication between the healthcare workers and patients. The study recruited 430 nurses who work at Al Qassimi Hospital and assessed their communication patterns during their routine activities. The study’s rationale involved the review of the incident report, which led to how poor communication leads to more than 65% of the sentinel cases reported in the hospital. The study gave the participants a self-administered questionnaire consisting of 10 questions covering crucial areas such as; magnitude, the consequence, reporting, reasons, and managing effective communication. Thirty-five nurses working at the Al Qassimi were randomly selected from the male surgical unit who participated in an awareness session about the SBAR tool. SBAR tool was then introduced and used in the same unit in order to determine its effectiveness. The results revealed that incidences arising from poor communication improved from 37.5% to 53%, and proper management of problems with communication improved from 21% to 28%. In addition, quality improvement was noticed during handovers significantly after implementing the ISBAR (P=0.001) 2. Personnel’s experiences were improved concerning the use of ISBAR handovers implementation (P<0.001) 3. personnel found it was easier to establish contact at the beginning of the handover, and they resolved any doubtful (P=0.001). This project improved healthcare providers’ communication, enhanced patient safety, saved staff time, and was included in the hospital’s strategic plan to be used by other healthcare professionals.

Executive Summary

Effective communication is vital in hospitals because it helps understand the patient and give appropriate treatment. Patient service is an essential aspect because it guarantees security and comfort. Research indicates that poor communication between the doctor and the patient is the sentinel cause of poor health outcomes (1). SBAR communication uses telephones as a framework between the nurses and patients such that the information is relayed in real-time. Patient safety is an important event that has the potential for injuries, poor or good treatment outcomes, and proper disease management. 2004 report indicates that hospitals in the US, Denmark, and Australia have average adverse effects of 3.2%-16.6% (24). Similarly, the condition in Indonesia as of 2007 was more than 46%, with the highest incidence in Jakarta.

This study analyzed the effects of SBAR communication through the telephone to improve communication between nurses and patients. The N value of the study was 430 nurses who work at Al Qassimi Hospital. The study assessed how they use the SBAR tool and how it influences their communication patterns during patient care. The study’s rationale involved the review of the incident report, which led to how poor communication leads to more than 65% of the sentinel cases reported in the hospital.

The methods used in the study included mixed sampling, where thirty-five staff nurses were randomly selected from the male surgical unit who participated in an awareness session about the SBAR tool. The tool was then introduced and used in the same unit, and the effectiveness of the tool in improving the quality of patient care and safety was evaluated. The exclusion and inclusion criteria for the study were determined by the reviewed articles. For instance, this article was excluded if articles described the SBAR tool but did not elaborate on the patient outcomes after using those tools. Other exclusions were those projects that did not focus on the SBAR tool since its use was not connected. Other studies that only reported team perceptions and survey outcomes but did not focus on the SBAR tool were excluded.

Results from the study indicate that reporting of incidences related to problems with communication improved from 37.5% to 53%, and proper management of problems with communication improved from 21% to 28%. As a result, it is essential to note the fundamental role played by electronic communication software. The study’s outcomes in Norway’s hospitals indicated a significant improvement in communication after introducing the SBAR tool. Also, the quality of handovers from nurses to other personnel improved significantly. Moreover, the implementation of SBAR handovers improved the experiences of nurses and medical personnel since they felt like the tool made their work more accessible and enjoyable.

Introduction

The SBAR tool is used during patient treatment to identify the various situations in medical facilities. The assigned personnel determine the background of the patient’s information and use it to assess their condition further. They then give these patients various recommendations according to their presented situations (12). The tool is beneficial to both the personnel and the patient in making their work more accessible since they get a systematic way of dealing with their issues. Nurses simplify their results by using the tool to formulate their thoughts and questions before approaching their patients. Nurses use the SBAR tool to improve patient care and safety, which is the purpose of this study. Besides, it determines the level of safety that comes with effective communication using the SBAR hand-off system (3). The SBAR hand-off electronic tool helps to improve communication between nurses and patients by providing a platform where they interact and communicate in real time.

Using the SBAR tool helps medical personnel to communicate only the necessary items to their patients, thus keeping the communication simple and easy to understand, especially for the patient. The nurse does not have to communicate all the details since some could not be important for the treatment (15). Using this tool also ensures that the nurses and medical personnel prioritize patient safety while working with them. They should hold discussions to get information out of the patient calmly and safely, not to harm the patient. The assessment involves giving professional conclusions about the patient’s situation that will help get the right solution for their problems (5). When nurses get all the information relating to the patient through the help of the SBAR tool, they then convey the same information to the rest of the medical team to deliberate on the best courses of action to treat the patient.

Since medical personnel uses the SBAR tool to improve communication between patients and the medical personnel, it is vital to determine patient safety when using the tool. The tool enhances patient safety by ensuring that the patient only discloses the relevant information used for their treatment. Patients also get better experiences when they divulge the correct information for their treatment (6). The nurses who deal with patients gain credible information by using the tool, making it easier to discuss the patient’s health with the rest of the healthcare team. The correct information from a patient will further help the medical staff to make better decisions regarding what treatments they will use on the patients or what medications they can administer to help them feel better (25). Proper use of the tool ensures that both the patient and nurses improve how they manage their time systematically. All these point out the safety that the SBAR tool enhances for the patients, thus making it a recommended tool for their everyday treatment.

Using the SBAR tool is also beneficial to nurses as it helps them arrange all the information they have regarding their patients in a logical manner. The information should be kept in ways that nurses can easily trace in case they need it for future use. Medical practitioners reduce errors by using this tool since they can easily retrieve any information regarding their patients (45). During recalls, the tool makes it easy to trace all information back to when the nurses obtained them and when or how they stored them. Since all medical practitioners are conversant with the SBAR tool, they have developed a mental model to share and understand information between them easily. They manage to break down any verbal or written patient information quickly (36). In doing so, they easily identify those situations that require immediate attention and work on them before the rest of the patients, thus improving patient safety.

Proper communication in the nursing field is vital in enhancing patient safety and increasing positive outcomes of treatments. Using the SBAR tool encourages effective communication that helps prevent possible adverse health outcomes and treatment of some symptoms when the patient presents them (15, 17, 42, 47). Excellent communication enables patients to be more open to their nurses about their illnesses, thus making it easier for them to present the proper diagnosis and the right treatment plan. A good communication strategy makes it easy for nurses to speak to their patients about the best health plans and educate them on what they should or should not do. Good communication between patients and nurses will improve their efficiency by ensuring both have all the information they need (24,28). Such information is crucial when nurses retrieve patient records for check-ups or conform to medical histories. The time constraints in communication are a non-issue as long as nurses achieve the best patient outcomes.

Objective

The following were the objectives of the study:

1. To evaluate different experiences from different countries regarding nurses using the SBAR during communication with their patients.
2. To identify the factors that determined how different personnel used the SBAR tool. Some of the elements included their age, gender, or professional backgrounds.
3. To investigate how using the SBAR tool would improve how nurses performed their jobs efficiently.
4. To determine how efficient the SBAR tool was in maintaining patient safety before and after using the tool.

Inclusion and Exclusion criteria

The researcher tested the SBAR tool in a clinical setting where patients and healthcare practitioners used the tool. The study’s main objective was to investigate the SBAR tool, which led to reporting patient outcomes regarding their views on using it. One of the patient outcomes identified was mortality, and nurses obtained these records using the SBAR tool. In addition, patient safety and outcomes were identified using parameters that identified the events leading to those outcomes.

The exclusion criteria were determined if articles described the SBAR tool but did not elaborate on the patient outcomes after using those tools. Other exclusions were those projects that did not focus on the SBAR tool since its use was not connected. In addition, other studies that only reported team perceptions and survey outcomes but did not focus on the SBAR tool were excluded. Finally, the study excluded articles that mention the SBAR tool but did not further explain the impact of its use on patient care.

Methods

The study was conducted in various countries and locations and in different years as listed below: The study used a randomized design where each participant had an equal chance of being included. The study sites included Leonardsen A-C, Klavestad Moen E, Karlsøen G, Hovland T. 2019, South-eastern Norway, Brown R. 2020, Texas, Pakcheshm B, Bagheri I, Kalani Z. 2020, Iran Hou YH, Lu LJ, Lee PH, Chang IC. 2019 and Taiwan. The study was conducted in different settings and contexts in all the selected countries where different health practitioners were involved. Different study sites helped determine the best control for the study because the geographic locations affected specific study parameters. All the nurses and medical personnel involved participated in the study thoroughly, thus recording credible results to answer other questions. There was no notable deviation from the approach used to obtain them.

Results

Table 1: Analytical Cross-Sectional Study

Table 2: Cohort Study

Table 3: Quasi-Experimental Study

Table 4: Characteristics of Included Studies – Analytical Cross-Sectional Study Form

Table 5: Characteristics of Included Studies – Quasi-Experimental Study Form

Discussion of Results

1. A quality improvement was noticed during handovers significantly after implementing the ISBAR (P=0.001).
2. Personnel’s experiences were improved concerning the use of ISBAR handovers implementation (P<0.001).
3. Personnel found it was easier to establish contact at the beginning of the handover, and they resolved any doubtful (P=0.001).

In addition, data was collected via recorded voices of 24 nurses with total 564 handoffs done, with 282 pre-intervention and 282 post-intervention handoffs done.

• Results over one week of patients indicated that:
  • pre-intervention 86.9%
  • post-intervention 100%
• Current position:
  • pre-intervention 90%
  • post intervention94%
• Clinical background:
  • pre-intervention 75.1%
  • post-intervention 80.1%
• Assessment of systems’ status:
  • pre-intervention 52.8%
  • post-intervention 92.2%
• Recommendation:
  • pre-intervention 80.1%
  • post-intervention 100%
• Gender:
  • Female 17 (70.8%)
  • Male 6 (29.2%)
• Age below:
  • 30 years 7(29.2%)
  • 30-39 years 11(45.8%)
  • above 40 years 6(25%)
• Level of education:
  • graduated 21 (87.5%)
  • MSc 3 (12.5%)
• Work experience:
  • Below ten years 10 (41.7%)
  • 10- 19 years 9(37.5%)
  • Above 20 years 5 (20.8 %)
• Type of shift:
  • fixed 3 (12.5%)
  • rotation 21 (87.5%).

ISBAR tool assured a smooth transfer of information among nurses and patients. The SBAR communication through the telephone reflects an improvement in implementing the patient safety program in the hospital.  As per the result that shows pre-intervention test: 26.11 / post-intervention test:36.70, that reflect an increase of by10.59 points.

Discussion

The study’s outcomes in Norway’s hospitals indicated noticeable improvements after introducing the SBAR tool. In addition, the quality of handovers from nurses to other personnel improved significantly. Moreover, the implementation of SBAR handovers improved the experiences of nurses and medical personnel since they felt like the tool made their work more accessible and enjoyable. Furthermore, they could quickly establish contact with their patients while using the tool, thus making it easy to resolve any issues and clear their patients’ doubts during their treatment. In the Texan hospital, the data obtained from the study indicated that there were more admissions of mentally unstable patients than in previous times. In addition, professionals in the hospital were more self-efficient and had more accurate data related to their patient admission. All these were due to the availability of the SBAR tool that enabled them to become more efficient in their work, specifically during pre-admissions and admissions.

The study aimed to improve patient care by enhancing communication between nurses and the patients. The study’s objectives pointed to improving the professional competency of the nurses during admission, care, and implementation of SBAR tool as a communication platform when communicating with the clinical or medical officer. The data collected and analyzed for the study indicated that SBAR improved the health professional method of communication, and the study’s objectives were met. Similarly, the results indicate a significant increase in self-efficacy of communication and the general practice of the nurses involved in the research project. For example, health intake within the study improved their self-efficacy and communication. Thus, SBAR hand-off electronic system improved communication within the hospital and helped to enhance patient care.

Strengths and Limitations of the Study

Research limitations of the study include the use of online questionnaires, which did not reach all the target groups, and a smaller sample size. Furthermore, online surveys have an intrinsic restriction because it is difficult to verify the authenticity of the information and determine whether the nurses themselves completed the questionnaires or were done by someone else (16). Therefore, due to the weaknesses of the online interview, it is not scientifically correct to make conclusions about the effectiveness of the hand-off system of communication among the nurses. Besides, the study area included five selected areas, giving it more power. However, the study areas have different dynamics that affect the participants’ responses; thus, it is hard to generalize the results. In addition, the SBAR electronic system under investigation was used by the nurses recruited into the study, but it is not clear whether it is the same system that other nurses use globally. Furthermore, the nurses’ biased answers gave a wider margin of error and produced different results, which is hard to analyse. Lastly, the study changed the nurses’ perception of the electronic hand-off system, which led to respondents’ bias (26). Therefore, the use of online questionnaires and bias responses by the recruited nurses contributed to the significant challenges of the study.

Implications for Practice and Future Recommendations

The research model that the study employed to accomplish its objective explains the importance of selecting an appropriate and effective hand-off electronic system, SBAR on nurses’ communication. Furthermore, the study incorporated specific factors that affect communication within the healthcare facility, which are the key factors that add value to the system development. As a result, the study recommends that every hospital have a hand-off SBAR system with a friendly interface that can relay information from the bedside to the doctors’ desk in real-time. In addition, nurses and other caregivers should receive appropriate training on boosting their cognitive and expressive abilities and help them understand how to use the software. Similarly, while conducting the study, the research team realized that more than 20% of hospitals rated by TJCHA are still using the paper system as a backup for the electronic system. Thus, the study recommends that hospitals embrace the SBAR platform to improve communication and avoid unnecessary paperwork. This exchange of knowledge and experience will help to revolutionize the hospital systems and improve the quality of care that the patients receive.

Conclusion

According to the reviewed articles, the SBAR communication tool is essential in improving professionalism and the quality of care that the patient receives. In addition, the tool helps to enhance smooth communication and transfer of information between nurses and patients, hence, improving the medical outcomes. The results showed that it is essential to educate the nurses and other medical practitioners to sustain using the SBAR tool in clinical practices. Education should include confounding factors such as cultural differences, which can affect the acceptance of the tool in a hospital. The projects served as a quality check for the communication systems and helped to improve the clinicians’ and nurses’ self-efficacy. The use of the SBAR tool was successful because it increased admission. This intervention successfully increased admissions to the medical units, including the neuropsychiatric unit at the study centers. The SBAR has been a great addition to the pre-admission assessment, and the mental health professional will continue to learn how to improve communication because of this intervention. Successful implementation requires the will to change and improve communication. This study supports other research that indicates that SBAR is a good structure for timely and effective communication between caregivers and patients.

References

[Internet]. 2021.

Abbaszade A, Assarroudi A, Armat M, Stewart J, Rakhshani M, Sefidi N Et al. Evaluation of the Impact of Hand-off Based on the SBAR Technique on Quality of Nursing Care. Journal of Nursing Care Quality. 2020;36(3): E38-E43.

Ahc M. Multidisciplinary Approach Helps with Hand-Off Communication Improvement. Same-Day Surgery [Internet]. 2019;43(10): N.PAG-N.PAG.

Ahmed M, Nirmal N, Al-Sabbagh A, Aslam M. Improving the quality of medical handover on a pediatric ward. British Journal of Hospital Medicine. 2018;79(10):584-585.

Alexander L, Bechan N, Brady S, Douglas L, Moore S, Shelley R. Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit. Ir Med J. 2018;111(6):767.

Bakon S, Wirihana L, Christensen M, Craft J. Nursing handovers: An integrative review of the different models and processes available. International Journal of Nursing Practice (John Wiley & Sons, Inc) [Internet]. 2017;23(2): n/a-N.PAG.

Bashir K, Shah Y. Using a Combination Approach in Imparting Effective Telephone Referral Skills to Emergency Medicine Residents in Qatar: A Pilot Study. Adv. Med Educ Pract. 2020; 11:187–90.

Beament T, Ewens B, Wilcox S, Reid G. A collaborative approach to implementing a structured clinical handover tool (iSoBAR) within a hospital setting in metropolitan Western Australia: A mixed-methods study. Nurse Education in Practice [Internet]. 2018; 33:107–13.

Beigmoradi S, Pourshirvani A, Pazokian M, Nasiri M. Evaluation of Nursing Handoff Skill among Nurses Using Situation-background-assessment-recommendation Checklist in General Wards. Journal of Evidence-based Care [Internet]. 2019;9(3):62–8.

Bonds R. SBAR Tool Implementation to Advance Communication, Teamwork, and the Perception of Patient Safety Culture. Creative Nursing. 2018;24(2):116-123.

Brewster J, Waxman P. Adding kindness at handover to improve our collegiality: The K-ISBAR tool. Med J Aust. 2019;211(2):93–93. e1.

Brown R. SBAR tailored mental health intake to improve mental health crisis triage for older adults [Internet]. 2020.

Burgener M. Enhancing Communication to Improve Patient Safety and to Increase Patient Satisfaction. Health Care Manager [Internet]. 2020;39(3):128–32.

Burgess A, van Diggele C, Roberts C, Mellis C. Teaching clinical handover with ISBAR. BMC Med Educ. 2020;20(Suppl 2):459.

Campbell B, Stirling C, Cummings E. Continuity matters: Examining the “information gap” in transfer from Residential Aged Care, ambulance to emergency triage in southern Tasmania. International Emergency Nursing [Internet]. 2017; 32:9–14.

Coolen E, Engbers R, Draaisma J, Heinen M, Fluit C. The use of SBAR as a structured communication tool in the pediatric non-acute care setting: bridge or barrier for interprofessional collaboration? J Interprof Care. 2020;1–10.

Cooper D, Keiser M, Berg K, Sherman E. Improving Interprofessional Communication Con? Dence Among Physical Therapy and Nurse Practitioner Students. Journal of Physical Therapy Education (Lippincott Williams & Wilkins) [Internet]. 2019;33(3):177–84.

Davis BP, Mitchell SA, Weston J, Dragon C, Luthra M, Kim J, et al. SBAR-LA: SBAR Brief Assessment Rubric for Learner Assessment. MedEdPORTAL. 2021; 17:11184.

Doyle C, Hamilton V, Bedding M, Cliffe K, Conroy C, Horgan S, et al. National Clinical Guideline No 6: Sepsis Management – A Quality Improvement & Safety Initiative. International Journal of Integrated Care (IJIC) [Internet]. 2017; 17:1–2.

SBAR communication through telephone affects effective communication in implementing the patient safety program. Pakistan journal of medical and health sciences [Internet]. 2018;12(3):1334‐1339.

Fahim Yegane SA, Shahrami A, Hatamabadi HR, Hosseini-Zijoud SM. Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients. Prehosp Disaster Med. 2017;32(5):541–7.

Feley K, Sullivan D. SBAR: An Apology & An Awareness to Inclusivity: A Diversity, Equity, and Inclusion Update. ISNA Bulletin [Internet]. 2021;48(1):19–19.

Foronda L, Walsh H, Budhathoki C, Bauman E. Evaluating nurse-physician communication with a rubric: A pilot study. The Journal of Continuing Education in Nursing [Internet]. 2019;50(4):163–9.

Franko S, Shah V, Hong L, Bommareddy A. Evaluation of long-term retention and utilization of the situation, background, assessment, recommendation (SBAR) communication technique. Curr Pharm Teach Learn. 2021;13(2):122–6.

Goh SL. Adding kindness at handover to improve our collegiality: The K-ISBAR tool [Internet]. 2019. p. 93–93.

Harris K, Dawson A, Poe T, Shirey Mr. Feature. Nurse Communication Strategies to Improve Patient Outcomes in a Surgical Oncology Setting. ORL-Head & Neck Nursing [Internet]. 2017;35(4):5–12.

Holtmann M. Does the utilization of interactive learning during TeamSTEPPS SBAR, CUS, and debriefing tool sessions increase the perceptions of teamwork and communication in the hospital setting? [Internet]. 2018.

Hou YH, Lu LJ, Lee PH, Chang IC. Positive Impacts of Electronic hand-off systems designs on Nurses’ communication effectiveness. J Nurs Manag. 2019;27(5):1055–63.

Irct20180725040592N. The effect of using SBAR handover approach on quality of nursing care. [Internet]. 2018.

Jevon P, Shamsi S, Cornforth S. Devising a protocol for calling 999 from a dental practice and using SBAR to ensure effective communication and handover. Br Dent J. 2020;229(10):661–6.

Ji Y, Han S, Wang B. Effects of situation-background-assessment-recommendation handover combined with detail nursing intervention on patients with infections. Am J Transl Res. 2021;13(8):9056–62.

Jurns C. Using SBAR to Communicate with Policymakers. Online Journal of Issues in Nursing [Internet]. 2019;24(1):13–13.

Kite L. FOCUS: Education part 2. Implementation of A Multi-Modal Patient Deterioration Education Program. Australian Nursing & Midwifery Journal [Internet]. 2017;25(2):45–45.

Kitney P, Tam R, Bramley D, Simons K. Handover using ISBAR principles in two perioperative sites – a quality improvement project. Journal of Perioperative Nursing [Internet]. 2020;33(4): e-38-e-45.

Koli T, Filippidou M. Audit on the Quality of Handovers of a Psychiatric Liaison Team in the UK: A Short Report. Psychiatr Danube. 2017;29(Suppl 3):536–40.

Lee H, Jang J. Effects of flipped-learning-based simulation for nursing students: a retrospective survey. Into J Mint Health Nurs. 2021;30(5):1263–73.

Lee R, Kim J. Relationship between Interprofessional Communication and Team Task Performance. Clinical Simulation in Nursing [Internet]. 2020; 43:44–50.

Leonardsen C, Moen E, Karlsøen G, Hovland T. A quantitative study on personnel’s experiences with patient handovers between the operating room and the postoperative anesthesia care unit before and after implementing a structured communication tool. Nursing Reports [Internet]. 2019;9(1):1–5.

Liu C-L. An evaluation of the effectiveness of integrating an SBAR Communication Tool in a teaching hospital to improve patient safety in Taiwan [Internet]. 2019.

Malfait S, Van Hecke A, Van Biesen W, Eeckloo K. Do bedside handovers reduce handover duration? An observational study with implications for evidence‐based practice. Worldviews on Evidence-Based Nursing [Internet]. 2018;15(6):432–9.

McGrath K, Elertson M, Morin T. Increasing Patient Safety in Hemodialysis Units by Improving Handoff Communication. Nephrol Nurs J. 2020;47(5):439–45.

O’Shea ER, Roney LN. SBAR: Not Just for Patient Hand-offs. Nurse Educator [Internet]. 2021;46(1):48–48.

Pakcheshm B, Bagheri I, Kalani Z. The impact of using “ISBAR” standard checklist on nursing clinical hand-off in coronary care units. Nursing Practice Today [Internet]. 2020;7(4):266–74.

Ruhomauly Z, Betts K, Jayne-Coupe K, Karanfilian L, Szekely M, Relwani A, et al. Improving the quality of handover: implementing SBAR. Future Health J. 2019;6(Suppl 2):54.

Speakman E, Yarrish J. Using SBAR and Huddles for Effective Interprofessional Communication. Imprint (00193062) [Internet]. 2018;65(4):42–4.

Steinhauser K, Beliveau J, Hendricks A, Lakis K. Improving Palliative Care Chaplain Communication with the Interdisciplinary Care Team Through Implementation of the SBAR Technique (QI606). Journal of Pain & Symptom Management [Internet]. 2020;59(2):502–3.

Stewart R. SBAR, Communication, and Patient Safety: An Integrated Literature Review. MEDSURG Nursing [Internet]. 2017;26(5):297–305.

Superville G. Standardizing Nurse-to-Nurse Patient Hand-offs in a Correctional Healthcare Setting: A Quality Improvement Project to Improve End-of-Shift Nurse-to-Nurse Communication Using the SBAR I-5 Handoff Bundle. Standardizing Nurse-To-Nurse Patient Hand-offs in a Correctional Healthcare Setting: A Quality Improvement Project to Improve End-Of-Shift Nurse-To-Nurse Communication Using the Sbar I-5 Handoff Bundle [Internet]. 2017;1–1.

Ting WH, Peng FS, Lin HH, Hsiao SM. The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department. Taiwan J Obstet Gynecol. 2017;56(2):171–4.

Wilson D, Kochar A, Whyte-Lewis A, Whyte H, Lee KS. Evaluation of Situation, Background, Assessment, and Recommendation Tool During Neonatal and Pediatric Interfacility Transport. Air Med J. 2017;36(4):182–7.

Footnotes

1. [Internet]. 2021. Web.
2. Abbaszade A, Assarroudi A, Armat M, Stewart J, Rakhshani M, Sefidi N Et al. Evaluation of the Impact of Hand-off Based on the SBAR Technique on Quality of Nursing Care. Journal of Nursing Care Quality. 2020;36(3): E38-E43.
3. Ahc M. Multidisciplinary Approach Helps with Hand-Off Communication Improvement. Same-Day Surgery [Internet]. 2019;43(10): N.PAG-N.PAG.
4. Ahmed M, Nirmal N, Al-Sabbagh A, Aslam M. Improving the quality of medical handover on a pediatric ward. British Journal of Hospital Medicine. 2018;79(10):584-585.
5. Alexander L, Bechan N, Brady S, Douglas L, Moore S, Shelley R. Quality Improvement of Clinical Handover in a Liaison Psychiatry Department: A Three-Phase Audit. Ir Med J. 2018;111(6):767.
6. Bakon S, Wirihana L, Christensen M, Craft J. Nursing handovers: An integrative review of the different models and processes available. International Journal of Nursing Practice (John Wiley & Sons, Inc) [Internet]. 2017;23(2): n/a-N.PAG.
7. Bashir K, Shah Y. Using a Combination Approach in Imparting Effective Telephone Referral Skills to Emergency Medicine Residents in Qatar: A Pilot Study. Adv. Med Educ Pract. 2020; 11:187–90.
8. Beament T, Ewens B, Wilcox S, Reid G. A collaborative approach to implementing a structured clinical handover tool (iSoBAR) within a hospital setting in metropolitan Western Australia: A mixed-methods study. Nurse Education in Practice [Internet]. 2018; 33:107–13.
9. Beigmoradi S, Pourshirvani A, Pazokian M, Nasiri M. Evaluation of Nursing Handoff Skill among Nurses Using Situation-background-assessment-recommendation Checklist in General Wards. Journal of Evidence-based Care [Internet]. 2019;9(3):62–8.
10. Bonds R. SBAR Tool Implementation to Advance Communication, Teamwork, and the Perception of Patient Safety Culture. Creative Nursing. 2018;24(2):116-123.
11. Brewster J, Waxman P. Adding kindness at handover to improve our collegiality: The K-ISBAR tool. Med J Aust. 2019;211(2):93–93. e1.
12. Brown R. SBAR tailored mental health intake to improve mental health crisis triage for older adults [Internet]. 2020.
13. Burgener M. Enhancing Communication to Improve Patient Safety and to Increase Patient Satisfaction. Health Care Manager [Internet]. 2020;39(3):128–32.
14. Burgess A, van Diggele C, Roberts C, Mellis C. Teaching clinical handover with ISBAR. BMC Med Educ. 2020;20(Suppl 2):459.
15. Campbell B, Stirling C, Cummings E. Continuity matters: Examining the “information gap” in transfer from Residential Aged Care, ambulance to emergency triage in southern Tasmania. International Emergency Nursing [Internet]. 2017; 32:9–14.
16. Coolen E, Engbers R, Draaisma J, Heinen M, Fluit C. The use of SBAR as a structured communication tool in the pediatric non-acute care setting: bridge or barrier for interprofessional collaboration? J Interprof Care. 2020;1–10.
17. Cooper D, Keiser M, Berg K, Sherman E. Improving Interprofessional Communication Con? Dence Among Physical Therapy and Nurse Practitioner Students. Journal of Physical Therapy Education (Lippincott Williams & Wilkins) [Internet]. 2019;33(3):177–84.
18. Davis BP, Mitchell SA, Weston J, Dragon C, Luthra M, Kim J, et al. SBAR-LA: SBAR Brief Assessment Rubric for Learner Assessment. MedEdPORTAL. 2021; 17:11184.
19. Doyle C, Hamilton V, Bedding M, Cliffe K, Conroy C, Horgan S, et al. National Clinical Guideline No 6: Sepsis Management – A Quality Improvement & Safety Initiative. International Journal of Integrated Care (IJIC) [Internet]. 2017; 17:1–2.
20. SBAR communication through telephone affects effective communication in implementing the patient safety program. Pakistan journal of medical and health sciences [Internet]. 2018;12(3):1334‐1339.
21. Fahim Yegane SA, Shahrami A, Hatamabadi HR, Hosseini-Zijoud SM. Clinical Information Transfer between EMS Staff and Emergency Medicine Assistants during Handover of Trauma Patients. Prehosp Disaster Med. 2017;32(5):541–7.
22. Feley K, Sullivan D. SBAR: An Apology & An Awareness to Inclusivity: A Diversity, Equity, and Inclusion Update. ISNA Bulletin [Internet]. 2021;48(1):19–19.
23. Foronda L, Walsh H, Budhathoki C, Bauman E. Evaluating nurse-physician communication with a rubric: A pilot study. The Journal of Continuing Education in Nursing [Internet]. 2019;50(4):163–9.
24. Franko S, Shah V, Hong L, Bommareddy A. Evaluation of long-term retention and utilization of the situation, background, assessment, recommendation (SBAR) communication technique. Curr Pharm Teach Learn. 2021;13(2):122–6.
25. Goh SL. Adding kindness at handover to improve our collegiality: The K-ISBAR tool [Internet]. 2019. p. 93–93.
26. Harris K, Dawson A, Poe T, Shirey Mr. Feature. Nurse Communication Strategies to Improve Patient Outcomes in a Surgical Oncology Setting. ORL-Head & Neck Nursing [Internet]. 2017;35(4):5–12.
27. Holtmann M. Does the utilization of interactive learning during TeamSTEPPS SBAR, CUS, and debriefing tool sessions increase the perceptions of teamwork and communication in the hospital setting? [Internet]. 2018.
28. Hou YH, Lu LJ, Lee PH, Chang IC. Positive Impacts of Electronic hand-off systems designs on Nurses’ communication effectiveness. J Nurs Manag. 2019;27(5):1055–63.
29. Irct20180725040592N. The effect of using SBAR handover approach on quality of nursing care. [Internet]. 2018. Web.
30. Jevon P, Shamsi S, Cornforth S. Devising a protocol for calling 999 from a dental practice and using SBAR to ensure effective communication and handover. Br Dent J. 2020;229(10):661–6.
31. Ji Y, Han S, Wang B. Effects of situation-background-assessment-recommendation handover combined with detail nursing intervention on patients with infections. Am J Transl Res. 2021;13(8):9056–62.
32. Jurns C. Using SBAR to Communicate with Policymakers. Online Journal of Issues in Nursing [Internet]. 2019;24(1):13–13.
33. Kite L. FOCUS: Education part 2. Implementation of A Multi-Modal Patient Deterioration Education Program. Australian Nursing & Midwifery Journal [Internet]. 2017;25(2):45–45.
34. Kitney P, Tam R, Bramley D, Simons K. Handover using ISBAR principles in two perioperative sites – a quality improvement project. Journal of Perioperative Nursing [Internet]. 2020;33(4): e-38-e-45.
35. Koli T, Filippidou M. Audit on the Quality of Handovers of a Psychiatric Liaison Team in the UK: A Short Report. Psychiatr Danube. 2017;29(Suppl 3):536–40.
36. Lee H, Jang J. Effects of flipped-learning-based simulation for nursing students: a retrospective survey. Into J Mint Health Nurs. 2021;30(5):1263–73.
37. Lee R, Kim J. Relationship between Interprofessional Communication and Team Task Performance. Clinical Simulation in Nursing [Internet]. 2020; 43:44–50.
38. Leonardsen C, Moen E, Karlsøen G, Hovland T. A quantitative study on personnel’s experiences with patient handovers between the operating room and the postoperative anesthesia care unit before and after implementing a structured communication tool. Nursing Reports [Internet]. 2019;9(1):1–5.
39. Liu C-L. An evaluation of the effectiveness of integrating an SBAR Communication Tool in a teaching hospital to improve patient safety in Taiwan [Internet]. 2019.
40. Malfait S, Van Hecke A, Van Biesen W, Eeckloo K. Do bedside handovers reduce handover duration? An observational study with implications for evidence‐based practice. Worldviews on Evidence-Based Nursing [Internet]. 2018;15(6):432–9.
41. McGrath K, Elertson M, Morin T. Increasing Patient Safety in Hemodialysis Units by Improving Handoff Communication. Nephrol Nurs J. 2020;47(5):439–45.
42. O’Shea ER, Roney LN. SBAR: Not Just for Patient Hand-offs. Nurse Educator [Internet]. 2021;46(1):48–48.
43. Pakcheshm B, Bagheri I, Kalani Z. The impact of using “ISBAR” standard checklist on nursing clinical hand-off in coronary care units. Nursing Practice Today [Internet]. 2020;7(4):266–74.
44. Ruhomauly Z, Betts K, Jayne-Coupe K, Karanfilian L, Szekely M, Relwani A, et al. Improving the quality of handover: implementing SBAR. Future Health J. 2019;6(Suppl 2):54.
45. Speakman E, Yarrish J. Using SBAR and Huddles for Effective Interprofessional Communication. Imprint (00193062) [Internet]. 2018;65(4):42–4.
46. Steinhauser K, Beliveau J, Hendricks A, Lakis K. Improving Palliative Care Chaplain Communication with the Interdisciplinary Care Team Through Implementation of the SBAR Technique (QI606). Journal of Pain & Symptom Management [Internet]. 2020;59(2):502–3.
47. Stewart R. SBAR, Communication, and Patient Safety: An Integrated Literature Review. MEDSURG Nursing [Internet]. 2017;26(5):297–305.
48. Superville G. Standardizing Nurse-to-Nurse Patient Hand-offs in a Correctional Healthcare Setting: A Quality Improvement Project to Improve End-of-Shift Nurse-to-Nurse Communication Using the SBAR I-5 Handoff Bundle. Standardizing Nurse-To-Nurse Patient Hand-offs in a Correctional Healthcare Setting: A Quality Improvement Project to Improve End-Of-Shift Nurse-To-Nurse Communication Using the Sbar I-5 Handoff Bundle [Internet]. 2017;1–1.
49. Ting WH, Peng FS, Lin HH, Hsiao SM. The impact of situation-background-assessment-recommendation (SBAR) on safety attitudes in the obstetrics department. Taiwan J Obstet Gynecol. 2017;56(2):171–4.
50. Wilson D, Kochar A, Whyte-Lewis A, Whyte H, Lee KS. Evaluation of Situation, Background, Assessment, and Recommendation Tool During Neonatal and Pediatric Interfacility Transport. Air Med J. 2017;36(4):182–7.