ISBAR a better way to communicate

A training package for UMHCS as part of the TeamSTEPPS project

1. ISBAR – a better way to communicate
Acknowledgement: Southern Health & VMIA

2. ISBAR helps clinical staff to:
•Further develop their communication skills
•Utilise these skills when making a telephone ‘referral’
•Utilise questioning / prompting skills when receiving a
telephone referral
•Use a standardised or common approach to
communication
•Adapted from SBAR, a tool developed by the US
Navy to improve communication

3. Why is improving our
communication important?
•Patient care is dependant on effective communication
- including telephone communication between all staff
involved in the care of the patient
• Effective communication has become more important
as healthcare has become more complex, highly
specialised and team-based

4. Why do we need a standard
approach to verbal and written
communication?
•It is a daily task
•It is rarely ‘explicitly’ taught
•Telephone referrals can be a source of frustration
for both the ‘giver’ and the ‘receiver’
• Ineffective telephone communication can
compromise patient care

5. Some questions for you to think
about…..
•How often do you make or receive a telephone
referral?
•Generally, is making a telephone referral easy or
difficult?
•Do you get frustrated when receiving information about
your patients/clients from other staff?
• What have you experienced?
•If sometimes difficult, why?
• What information would you like when receiving a
referral or at handover?

6. Some of the challenges in good
communication
• People are busy and don’t want more work! It takes time
and practice to plan a good handover of patient/client
information
•It can be difficult to summarise a complex case
succinctly
•The person making the referral:
– is often asked about things they have already said
– may not get the help they were expecting
•The person receiving the referral may
– interrupt mid-sentence
– make assumptions about the capability of caller

7. Video 1
Click on the black box and watch
the video
•What are your thoughts on this
doctor’s attempt at making
a referral?
•What suggestions for
improvement would you give
him?

8. He was focused, but not well
prepared….
1. The doctor clearly states what he wants:
– he wants the other doctor to come and see the
patient
2. He checks he is talking to the right person
but …
- He doesn’t have important information at hand
3. The main problem is lack of preparation
- how long does it take to prepare?
- what things should be prepared before picking up the
telephone?

9. Video 2
Click on the black box again and
watch a second video
•What are your thoughts on this
doctor’s attempt at making
a referral?
•What suggestions for
improvement would you give
him?

10. Once again, prepared, but not
focused
•This was obviously very exaggerated, however…
• The person on the other end of the phone gave up
because the information was neither concise nor
organised
• All the relevant information was included, but the
message was not clear
•Note: the relevant information needs to be delivered
slowly and simply with appropriate emphasis and
repetition

11. ISBAR – what does it stand for?
I - Identify
S - Situation
B - Background
A - Assessment
R - Request

12. I = Identify
•Identify yourself - name, position, location
Identify the person you are talking to if not already
done
•Identify the patient and unique ID number
“Hello. My name is Jasmine Sass, I’m a Division 1 RN
working in Acute at UMHCS. Are you the Doctor on call
today? … I’m calling about a patient - Terry Jones –
a 56 year old man in our Acute ward at present”

13. I = Identify
•Why give your name?
– it is polite and professional to do so
•Why give your position?
– helps the information receiver to know at what level
to pitch their response/advice
• Why state where you are calling from?
– the information receiver may work at multiple sites
• Why identify the person you are speaking to?
– to make sure it is the appropriate person

14. I = Identify
•Why do you need their name?
– to document in the notes for future reference
•Why identify the patient - name, age, sex, location?
– helps identify the patient and helps the receiver to develop
a mental picture of the patient

15. S= Situation
•Explanation of WHY you are calling
“I am calling you about a patient, Mr Jones. He is a 56
year old man, 3 days post total knee replacement who has
developed new atrial fibrillation with a blood pressure
of 105/66. He looks pale and feels unwell. I would like
you to come and assess this patient please”

16. S = Situation
•If urgent, make this clear at the start
“Mr Jones is a 56 year old man who is 3 days post total knee
replacement and is here for rehabilitation. He has gone into atrial
fibrillation. He is stable at present with a blood pressure of 105/66 but
he is normally hypertensive. He looks pale and feels unwell. I am
concerned about him and would appreciate it if you could come and
help us stabilise him”
•Stating the purpose of the call at the start of the
conversation helps the receiver focus their attention
appropriately when listening to the story

17. B = Background
• Tell the story
“I’ll tell you the story…”
“I’ll give you the background information…”
• Provide RELEVANT information only. Deciding what is
relevant is a skill that comes with experience
• Don’t forget ‘less is often more’
– you may get the message across better with less
Information
• Include aspects of history, examination, investigations and
management where relevant

18. B = Background
•The volume of information will depend on the situation
– Less
• if the receiver will see the patient themselves shortly. No
background may be quite appropriate in this situation.
• if the receiver already knows the patient
– More
• if you are wanting management advice over the phone
without the receiver seeing the patient
•The receiver can always fill any important
gaps in your story by asking questions

19. A = Assessment
• State what you think is going on. Give your
interpretation of the situation
•This is NOT about providing your diagnosis of the patient –
only a qualified medical practitioner can do this
• Don’t leave the receiver to guess what you are thinking
- Stating the obvious is helpful here
-Include your degree of certainty
-Be objective

20. A = Assessment
• “… the patient is febrile with a temperature of 39
deg”
• “The patient has improved but I am concerned
they are still short of breath”
•“The patient has rated their pain at 8/10 despite
2.5 mg Morphine IV one hour ago”

21. R = Request
State what you want from the receiver
•“We would be grateful for your opinion regarding the
need for surgery”
•“I need help urgently, are you able to come now? …if not,
who should I call?”
Ask questions
•“What would be the most appropriate pain relief we can
administer until you are able to come and assess the
patient?
•“What would you like me to do for the patient whilst waiting
for you to come in?”

22. Additional points …..
•What you say for Situation may be a concise summary of
what you say for Assessment and Request. This repetition
is helpful, as it emphasises the key purpose of the referral,
as well as why it is important they come NOW!
•Sometimes the receiver will lead the conversation – you
can still use ISBAR as a guide
– Don’t forget, the receiver may not be familiar with ISBAR
•Practice makes perfect – use the ISBAR documentation
form to help you organise the information you are going to
convey

23. Preparing for the call
•Preparation is vital - use ISBAR to prepare
•Make sure YOU are clear on the reason for referral
before calling
•Write down your questions
• Document a written referral in the notes as per the
practice for formal referrals in your hospital or include in
nursing notes
•Gather relevant patient details, notes, charts, ECGs,
observations etc before making the call
•Have pen and paper on hand to write down names,
numbers and instructions, or use the ISBAR
documentation form

24. ISBAR template form
Use this form
to prepare before
presenting your client

25. Video 3 – how to do it properly
•Click on the black box to watch
the last clip
•What are your thoughts on this
attempt at making a
referral?
•This is an example of ISBAR in
action!

26. Remember, ISBAR can be brief
• I - “Hi, I’m Carol, an ANUM in Acute today”
• S - “I would like you to come and see a 21 year old man
who has had a significant skin reaction to an IV antibiotic”
• B - “He was admitted this morning for treatment of an
appendicectomy wound infection. He is a type 1 diabetic.
He has just had his first dose of Gentamicin,Metronidazole
and Ampicillin”
• A – “He is anxious and appears flushed with an erythemous
rash on his chest and arms. His blood pressure is normal”
• R - “Are you able to see him urgently?”
“What would you like me to do in the meantime?”

27. Receiving a referral or handover
Don’t forget you can help – you may need to help people stay
on track – consider asking the following questions
– Are we using the ISBAR format?
– Can you give this to me in ISBAR format?
– Can you please identify …. patient’s name, location?
– What is the Situation?
– What is the Background?
– What is your Assessment?
– What do you think needs to happen?

28. Other applications of ISBAR
•Making a written referral
•Presenting a case on a ‘ward round’
•Handing over a complicated patient to covering staff
•When transferring or receiving a patient from ED
• ‘Standardised Forms’ development

29. How are we going to use ISBAR
at UMHCS?
•At nursing handover
•Making calls to our GP’s, or other allied health professional referrals
•To present patients at the Continuum of Care meeting or brief
•In our written documentation
•As part of the review process of a number of our forms we use
including the Multidisciplinary Assessment Tool, Referral forms etc –
this is part of the PDSA project
•To improve the quality of the information we share among one another
about our clients and patients
•To improve our efficiency and time during handover and meetings

30. What next?
•Print out your certificate of completion
•Start practicing using ISBAR in your daily work
•Be ready to start the trial of using ISBAR in nursing
handover on May 30
•Feel free to see Sharon Ed, Krystal Sheehan, Liz Wallace
Joy Gadd or Fiona O’Toole if you have any further
questions or need clarification, they’re the group working
on SBAR and the whiteboard for the TeamSTEPPS project