title: SBAR improves nurse-physician communication and reduces unexpected death: a pre and post intervention study.
abstract: BACKGROUND
  The Joint Commission International Patient Safety Goal 2 states that effective communication between health care workers needs to improve. The aim of this study was to determine the effect of SBAR (situation, background, assessment, recommendation) on the incidence of serious adverse events (SAE's) in hospital wards.
  
  
  METHODS
  In 16 hospital wards nurses were trained to use SBAR to communicate with physicians in cases of deteriorating patients. A pre (July 2010 and April 2011) and post (June 2011 and March 2012) intervention study was performed. Patient records were checked for SBAR items up to 48 h before a SAE. A questionnaire was used to measure nurse-physician communication and collaboration.
  
  
  RESULTS
  During 37,239 admissions 207 SAE's occurred and were checked for SBAR items, 425 nurses were questioned. Post intervention all four SBAR elements were notated more frequently in patient records in case of a SAE (from 4% to 35%; p<0.001), total score on the questionnaire increased in nurses (from 58 (range 31-97) to 64 (range 25-97); p<0.001), the number of unplanned intensive care unit (ICU) admissions increased (from 13.1/1000 to 14.8/1000 admissions; relative risk ratio (RRR)=50%; 95% CI 30-64; p=0.001) and unexpected deaths decreased (from 0.99/1000 to 0.34/1000 admissions; RRR=-227%; 95% CI -793 to -20; NNT 1656; p<0.001). There was no difference in the number of cardiac arrest team calls.
  
  
  CONCLUSIONS
  After introducing SBAR we found increased perception of effective communication and collaboration in nurses, an increase in unplanned ICU admissions and a decrease in unexpected deaths.
authors.affiliation: Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium. koen.demeester@ua.ac.be
authors.forename: K
authors.initials: K
authors.lastname: De Meester
authors.forename: M
authors.initials: M
authors.lastname: Verspuy
authors.forename: K G
authors.initials: KG
authors.lastname: Monsieurs
authors.forename: P
authors.initials: P
authors.lastname: Van Bogaert
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D003422:Critical Care / Q000592:standards; D003645:Death, Sudden / Q000517:prevention & control*; D018450:Disease Progression; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control*; D005260:Female; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006801:Humans; D007362:Intensive Care Units; D033183:Interdisciplinary Communication; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000592:standards; D061214:Patient Safety; D019555:Physician-Nurse Relations; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016019:Survival Analysis
keywords: Inter-professional communication; Rapid response system; SBAR; Serious adverse event; Un-expected death; Unplanned intensive care unit admission