SBAR and me

3 02 2011

For those of you who don’t know about it, SBAR is a handy acronym used in the NHS (because if there’s one thing the NHS needs, it’s more acronyms </sarcasm>) that can be used communicating information. Now, I’d not stumbled on this little piece of of the interwebs before, and none of the hosptials I’d been placed in had used it. Until this year.

It’s now a month since I first heard about it, and thought it was time to reflect a little on my experience.

At a first glance, it seems kind of intuitive. Thie pieces of SBAR are:

S – Situation. Describing the current status/problem succinctly

B – Background. What has lead up to this? What are the salient points from the history?

A – Assessement. What have you done? What have you found? What does this tell you about what might be going on?

and finally

R – Reccomendations. SBAR as I’ve seen it has been used in handovers, so this is what the team handing over care recommend that the team taking over care should do.

There is a lot about this that I really get on with. It seems like a nice idea to begin with the key issue, sets the tone, allows the person you’re talking to to get a snapshot idea of what’s going on, particularly important in where patients have more complex histories or care issues. Often as I’ve come across patients being presented to colleages in the past, the order of the current situation and background may be flipped (as in “This is a x year old lady with a background of y and z, presenting with a”), so this has taken a little getting used to for me.

Another excellent aspect of the SBAR format is that it positively encourages doctors (in particular more juniour doctors) to engage in patient’s care more directly, by allowing them the opportunity (in fact, the format demands it) to make a management plan and vocalise it to others (the recommendation).

As well as handover, I have also been encouraged to use the format during an adrenaline fuelled simulation session, trying to get a registrar to come and see my increasingly sick (pretend) patient. Knowing that I was supposed to be using SBAR, and so was allowed to make firm recomendations to my senior (in this case, something along the lines of “drop what you’re doing and come help me NOW!!!!”) was very empowering!

However, even after amonth, something hasn’t quite gelled. I love the narrative of medicine. I love the descriptions patients use. I love engaging with people, and find it difficult to distill human interaction into a one line “neurology advised x”. Perhaps this is why I’ve always felt more of an affinity with the more narrative-based specialties (GP, psychiatry…) over the more ‘snapshot’ specialties. Without begining at the begining and working my way through, I know that I find it difficult to remember things. So SBAR can be something of a challenge.

In real life, we often come across several problems, and will solve some whilst still turning up new issues to be considered. This ‘disordering’, this natural chaos, is the environment my brain has learnt to cope with. To suddenly impose rigid barriers between the synthesising and exploration of theories feels artificial.

This is even more so in pressured situations. What I found with the simulated session was that my ability to synthesise the narrative of what was happening into an SBAR format felt nigh on impossible. Details bled away, my mind felt scrambled, and all I had to hang on to was “oh, I need to give my assessment now” rather than actually thinking about what information needed to be got across, what problems we’d encountered, and what steps we’d already taken to help the situation.

I am sure this is a tool that I will discover when it can be used well. I am sure I will also learn to use it at times I currently find difficult. But not today.

Jx

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“no decision about me without me” part the first

14 07 2010

“No decision about me without me.” Liberating the NHS.

Some of you might have heard that – buried between an international footballing tournament and second by second updates on a gunman in Northumberland – the government has released their plans for a total upheaval within the NHS.

Now, whether you’ve been sat in a waiting room for 2 hours, or had the misfortune to go to a party with a ‘medical bore’, it would be difficult to escape the relentless manager-bashing that has grown over the past few years. When things don’t work as they should in hospitals, a mere reference to the problems being all because of “too many managers” explains the whole thing away. Health professionals and patients alike bemoan the powers granted to these people who – as far as we can see – often have little experience with healthcare, and maybe applying a business model to the lives and health of individuals feels a little… well, icky.

Well, it turns out some govenrment bod has listened to this common doctors’ gripe, and turned round to the PM and gone “y’know what, lets give them what they say they want”.

My understanging of the report – and I’m still digesting it, so expect an update over the coming days – has it boiled down to a few key points.

  1. The NHS is great – the government loves what it sets out to achieve and wants it to be even better.
  2. Patient choice should be in the forefront of everyone’s minds for the future of the NHS.
  3. “Targets” are to be replaced by “clinically credible and evidence based outcome measures”.
  4. The relationship between the government and drug developers may become interesting, and a fund will be set up to pay for those oh so expensive cancer drugs.
  5. The roles of the current commissioners (i.e. people who decide what the limitted pot of money should be spent on and wwhere provides services) with be taken over by groups of GPs who will be in charge of commissioning most of what their patients need, apart from the primary care bits, which will be looked at by another group (The NHS Commissioning Board).

This is potentially a massive change in how the NHS works. All I want to say for now is that I love our National Health Service. I am passionate about how fantastic it is. Sure, things could be better, but what we have in the UK is an example to the rest of the world. I look to see how this document will translate in practice with great interest.

Jx