Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting

Abstract

Objective To determine whether exposing junior doctors to Situation, Background, Assessment, Recommendation (SBAR) improves their telephone referrals. SBAR is a standardised minimum information communication tool. Methods A randomised controlled trial with participants and rating clinicians both blinded to group allocation. Hospital interns from a 2-year period (2006e2007) participated in two simulated clinical scenarios which required them to make telephone referrals. The intervention group was educated in SBAR between scenarios. Pre and post intervention telephone referrals were recorded, scored and compared. Six-month followup and year group comparisons were also made. An objective rating score measured the presence of specific 'critical data' communication elements on a scale of 1e12. Qualitative measures of global rating scores and participant self-rated scoring of performance were recorded. Time to 'first pitch' (the intern's initial speech) was also recorded. Results Data were available for 66 interns out of 91 eligible. SBAR exposure did not increase the number of communication elements presented; objective rating scores were 8.5 (IQ 7.0e9.0) for SBAR and 8.0 (IQ 6.5e8.0) for the control group (p¼0.051). Median global rating scores, designed to measure 'call impact', were higher following SBAR exposure (SBAR: 3.0 (IQR 2.0e4.0); control: 2.0 (IQ 1.0e3.0); p¼0.003)). Global rating scores improved as time to 'first pitch' duration decreased (p¼0.001). SBAR exposure did not improve time to 'first pitch' duration. Conclusion In this simulated setting exposure to SBAR did not improve telephone referral performance by increasing the amount of critical information presented, despite the fact that it is a minimum data element tool. SBAR did improve the 'call impact' of the telephone referral as measured by qualitative global rating scores.

SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study

“…Studies evaluating SBAR have been conducted in the USA,8–10 Canada,11 12 Australia,13 14 the UK,15 Belgium16 and the Netherlands 17. The results have shown an improved collaboration and nurse–physician communication, as perceived by nurses working in surgical and medical wards 16.…”

The structured communication tool SBAR (Situation, Background, Assessment and Recommendation) improves communication in neonatology

“…This can be simplified as follows: [6] • Situation: What is going on with the patient? The use of SBAR has been shown to increase the impact of telephone referrals between doctors, [7] and decreases the time taken for junior doctors to relay key facts in an emergency situation. [8] Doctors are assisted in making clinical decisions from a nursing report when SBAR is used.…”

“…[9] Most notably, SBAR decreases unexpected patient deaths when taught to nursing staff, along with training in airway-breathing-circulation resuscitation. [10] SBAR is currently in use in the UK, [2] Europe, [10] the USA [7] and Australia. [8] …”

Improving Escalation of Care

“…12 The point biserial correlation was used to compare the dichotomous scores from the SBAR tool with the ordinal data from the QUIT tool. 18 A correlation value (r) of 0.5 or more is considered a moderate positive correlation and a value of 0.7 or more is considered a strong positive correlation.…”

“…Therefore, perhaps unsurprisingly, reports suggest that these tools have not improved critical information transfer during a referral process. 12 A validated metric for objectively measuring the quality of information transfer needs to be developed before information transfer during escalation of care referrals can be improved.…”