title: Evaluation of a problem-specific SBAR tool to improve after-hours nurse-physician phone communication: a randomized trial.
abstract: BACKGROUND
  After-hours telephone communications are common in patient management. Patterns of communication of key information during after-hours phone calls were evaluated, and the utility of problem-specific Situation, Background, Assessment, Recommendation (SBAR) forms in improving this communication was assessed.
  
  
  METHODS
  In a randomized trial using a simulated on-call setting, 20 nurses called physicians regarding six cases adapted from inpatient records and based on the six most common reasons for after-hours nurse-physician communication. Three of the cases were handled without the SBAR forms (control cases), and three cases were handled with the forms (SBAR cases). Two cue types of communication were evaluated: situation cues, which conveyed the patient's situation (for example, a patient is confused), and background cues, which conveyed problem-specific data indicated on the SBAR forms (for example, the patient has a low sodium level).
  
  
  RESULTS
  Ninety-two phone calls were analyzed (43 SBAR/49 controls). Most of the nurses reported the situation cues (SBAR 88%, control 84%, p = .60) but not the background cues. There was a trend toward fewer background cues communicated in the SBAR cases (14% versus 31%, p = .08). In 14% of the cases, on average, nurses omitted information or reported wrong information regarding the background cue. Physicians asked questions that resulted in the communication of the cues in a minority of the cases when the background cues were not originally provided by the nurses (SBAR 6%, control 16%, p = .39).
  
  
  CONCLUSIONS
  In after-hours phone communication between physicians and nurses, significant information was often not communicated and physicians did not elicit the necessary information. Simply providing an SBAR-based form did not ensure complete communication of key information.
authors.affiliation: School of Biomedical Informatics, University of Texas Health Science Center at Houston, USA.
authors.forename: Erel
authors.initials: E
authors.lastname: Joffe
authors.forename: James P
authors.initials: JP
authors.lastname: Turley
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Hwang
authors.forename: Todd R
authors.initials: TR
authors.lastname: Johnson
authors.forename: Craig W
authors.initials: CW
authors.lastname: Johnson
authors.forename: Elmer V
authors.initials: EV
authors.lastname: Bernstam
mesh_terms: D039602:After-Hours Care / Q000379:methods / Q000458:organization & administration*; D057189:Checklist; D003266:Continuity of Patient Care; D006801:Humans; D007297:Inpatients; D033183:Interdisciplinary Communication; D007388:Internal Medicine; D008505:Medical Staff, Hospital / Q000458:organization & administration / Q000592:standards; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000592:standards; D019555:Physician-Nurse Relations; D012017:Referral and Consultation / Q000458:organization & administration / Q000592:standards*; D013689:Telephone