The SBAR Communication Framework

SBAR is the UK standard structured communication framework. NHS England adopted it across the system after research showed that structured communication reduced miscommunication errors compared to unstructured handover.

The four letters give the speaker a fixed sequence to follow and the listener a predictable structure to absorb.

The four sections

S — Situation

What is happening now.

The opening section names you, the patient, and the immediate concern. Brief: two or three sentences.

Example:

“This is Sarah, the staff nurse on Ward 12. I’m calling about Mrs A in bed 4. She’s a 72-year-old admitted yesterday with pneumonia, and her NEWS2 has just risen to 7.”

The Situation tells the listener what they’re about to hear about and signals the urgency.

B — Background

The clinical context that’s relevant.

Past medical history, recent events, current medications, allergies, but only what’s relevant to the current concern. Two to four sentences usually.

Example:

“She has COPD on the long-term oxygen list, hypertension and atrial fibrillation on warfarin. Admitted yesterday with community-acquired pneumonia, started on co-amoxiclav. Was stable until about 30 minutes ago when she became more breathless.”

The Background gives the listener the context to make sense of the current picture.

A — Assessment

Your clinical assessment: what you think is happening and the evidence for it.

This is the section where you summarise vital signs, ABCDE findings, and your clinical impression. The most demanding section.

Example:

“Her observations are RR 28, SpO2 88% on 2L nasal cannula (was 94% earlier), pulse 110 irregular, BP 130/85, temp 38.2, AVPU alert. NEWS2 is 7. She’s confused which is new compared to her baseline. I think she’s deteriorating, possibly the pneumonia progressing, possibly aspiration given the confusion, possibly something else.”

The Assessment is where you give the listener your professional judgement, not just numbers.

R — Recommendation

What you’d like the listener to do.

The closing section asks for a specific action. Don’t end without this. An SBAR that stops at A leaves the listener wondering what’s needed.

Example:

“I’d like you to come and review her urgently. I’m increasing her oxygen to 4L while I wait. Should I take blood cultures and lactate while you’re on your way?”

The Recommendation makes the request specific. The listener responds with an action plan rather than asking what you want.

Why SBAR works

Three properties of the framework reduce communication failure:

1. Predictability. The listener knows what’s coming. After 50 SBARs, both speaker and listener share an expectation about what sits in each section.

2. Completeness. Unstructured handover often skips sections, particularly the Assessment (the speaker’s judgement) and the Recommendation (the specific ask). SBAR forces inclusion.

3. Speed. With practice, SBAR is faster than unstructured speech for complex clinical pictures. The structure prevents tangents.

Common SBAR mistakes

Skipping S. Going straight into clinical detail without saying who and what about. The listener spends the first 30 seconds figuring out what they’re hearing.

Over-stuffed B. Including every detail of the patient’s history rather than only what’s relevant. Long B sections lose the listener.

Weak A. Giving the numbers without saying what you think they mean. “Vital signs are X, Y, Z” isn’t an assessment. “I think this patient is deteriorating because…” is.

No R. Ending with “I just wanted to let you know.” The listener doesn’t know what to do.

SBAR mid-conversation. Starting an SBAR halfway through a chat about something else. Use SBAR for the formal communication, separately from other conversation.

SBAR for shift handover

The same structure scales to whole-shift handover:

• S: ward overview, total patient count, bed status, any major concerns at handover.
• For each patient:
  • S: name, bed, primary issue.
  • B: relevant history and admission.
  • A: current status, recent observations, things to watch.
  • R: what needs doing in the next shift.

Per-patient SBAR keeps handover focused. The whole-shift handover should run 15-30 minutes for a typical ward.

SBAR in the OSCE

The OSCE Implementation station may include an escalation scenario where SBAR is the expected communication. Practice the structure aloud. Verbalising SBAR is harder than reading about it.

In the OSCE, deliver each letter clearly. Some candidates flag them aloud (“S, situation: I’m calling about Mrs A…”); others just follow the structure without labelling. Both work; the examiner is marking that the structure is present.

SBAR variations

Some trusts use variants:

• ISBAR: adds “Identification” at the start (formal introduction of self and listener).
• SBARR: adds “Read-back” (listener summarises back what they heard).
• iSBAR: lowercase i for identification at the start.

The core is SBAR. Variations are organisational preferences.

The next chapter covers drug calculation formulas, the practical reference card UK nurses need.