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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