Saving Lives: Effective Healthcare Communication Empowers Care Management

In healthcare, there is room for improvement in the communication between care teams. Communications gaps are thought to account for a significant portion of adverse events, particularly during handoffs (such as from the inpatient to ambulatory setting). The Joint Commission has estimated that handoff miscommunication is responsible for 80 percent of serious medical errors, raising the need for tools and practices that support improved communication.

A communications framework that outlines essential elements can help clinicians convey important information and is a key component of a care management plan. One such tool, SBAR (Situation, Background, Assessment, Recommendation), establishes common expectations about the information clinicians share and how they structure the communication. SBAR’s standardized communications approach also helps nurses and physicians build trust around sharing information, and creates open and structured communication between members of the care team.

This article explains how an integrated, effective communication methodology, such as SBAR, can help health systems avoid medical errors and improve outcomes and the patient experience.

An Effective Healthcare Communication Strategy Delivers Critical Information in a Timely Way

Doug Bonacum, the vice president of safety management for Kaiser-Permanente in Denver, developed SBAR in an effort to bridge the communication gap between nurses and physicians. Bonacum based the guidelines for consistent and concise handoffs on his experience on a Navy submarine, where crew members often needed to communicate strategy in less than 60 seconds.

Similar to a submarine, healthcare information handoffs tend to involve complex messages; the accurate and timely delivery of these messages can be a life or death matter. As clinicians see more patients in shorter time frames, quality care increasingly relies on an effective communication and handoff methodology. By using a concise format, such as SBAR, clinicians share only the relevant information they need to make an efficient, informed care decision.

An Effective Communication Strategy Must Be Integrated into the Workflow and Culture

A communication tool is most effective when organizations standardize it as a regular part of workflows and make it part of the culture. For example, one health system saw improved SBAR compliance when they gave clinicians SBAR reminder pocket cards and posted summaries of the methodology at each telephone. The entire organization soon adopted SBAR guidelines in all communication.

Organizationwide adoption of a communication methodology is critical in today’s interdisciplinary, patient-centered care. Today’s healthcare setting requires a collaborative team approach that includes physicians, nurses, nurse care managers, social workers, community health workers, and patients at the front of the team.

The SBAR Four-Part Communications Toolkit

The SBAR communication model, a leading healthcare methodology, has four parts that streamline healthcare communications:

1. Situation (S)

Under part one: situation, a clinician gives a concise statement about the patient’s current situation; for example:

• A 72-year-old female patient was admitted from the emergency department. The patient had fallen at home, resulting in a severe ankle sprain and a fractured wrist that required surgery. As an inpatient, she hasn’t participated in physical therapy for two days.
• A 45-year-old male patient has been discharged home and has no family to help with self-care and daily chores. The nurse care manager visits the patient at home and finds the patient sitting in pajamas in a dark room; the home is dirty and disorganized, and the refrigerator is empty.

2. Background (B)

Under part two: background, clinicians provide brief and pertinent information related to the current situation; for example:

• In order to discharge the female patient, the patient must be able to climb five steps to enter her home and move (not walk) 100 feet using a cane for support while wearing a walking boot.
• The male patient has refused home health nurses over past 30 days and has lost 10 pounds over past three months.

3. Assessment (A)

Under part three: assessment, the clinician analyzes the situation and background, and considers intervention options; for example:

• When the physical therapist comes in, the female patient may be in pain. She only takes Tylenol as needed at night and has not requested Tylenol during the day.

4. Recommendation (R)

Under part four: recommendation, the clinician requests or recommends an action to address the situation; for example:

• For the female patient, the nurse care manager recommends that the physician order pain medication before the patient’s physical therapy, which may make it easier to participate in therapy.
• For the male patient, the nurse care manager recommends a follow-up visit with the primary care provider for a depression assessment or referral to a behavioral health specialist.

Effective Communication Drives Care Management and Outcomes Improvement 

A consistent strategy for effective healthcare communication improves efficiency and provides a best practice method that optimizes the sharing of patient information. Health systems can reduce their risk of medical error by integrating a communication framework into their care management that, such as SBAR, defines the concise, vital, and relevant information for successful care team handoffs.

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