SBAR (Situation, Background, Assessment, Recommendation)
SBAR is a four-part structure for a clinical handoff or an urgent escalation: Situation, a concise statement of the problem; Background, the pertinent and brief history; Assessment, what you found and what you think; and Recommendation, what you want to happen. Michael Leonard, Doug Bonacum, and Suzanne Graham developed it at Kaiser Permanente of Colorado, and the Institute for Healthcare Improvement describes it as a concrete way to frame any conversation that needs a clinician's immediate attention and action. Haig and colleagues published an early hospital-wide implementation in the Joint Commission Journal on Quality and Patient Safety in 2006.
The part learners drop is the R. Situation, Background, and Assessment come naturally to anyone who has presented a patient, and then the call ends without a request, leaving the person on the other end to work out what was being asked for. IHI's own wording is blunt about it: the Recommendation is the action requested or recommended, what you want. A nurse who has to say out loud that they want the resident at the bedside now is doing something socially harder than reciting a history, and that is the skill SBAR exists to make routine.
This is why SBAR is a hierarchy tool as much as a communication tool. The structure gives a junior clinician a sanctioned script for stating an assessment and a request to someone more senior, which is exactly the moment where deference tends to soften a message into a hint. The Joint Commission has repeatedly named communication a leading root cause of sentinel events in Sentinel Event Alert 58, and the failures described there are frequently not missing information but information that was passed along too gently to prompt action.
SBAR faces the other clinician, which distinguishes it from the patient-facing frameworks it sits beside in a hospital's training catalog. AIDET, teach-back, and the Kalamazoo elements are about the encounter with the patient. SBAR is about the phone call, the escalation, and the handoff, and it belongs to the interprofessional side of a communication curriculum along with tools such as I-PASS and TeamSTEPPS. A program that trains only patient-facing skills leaves the escalations untouched, and those are where the deterioration gets missed.
The common failure mode is turning SBAR into a form. Once it becomes four boxes in the record, the exchange it was designed to structure stops happening, and staff complete the template after the call rather than using it during. It is a spoken protocol, so training it needs spoken repetition under something like real time pressure, with the recommendation said out loud to a person who might push back. That is difficult to schedule and is the reason most SBAR education stops at a laminated card.
What this looks like in a program
- Score the Recommendation separately. A learner who nails Situation, Background, and Assessment and never states a request has not completed an SBAR.
- Escalation practice needs a listener who can push back, because the skill is holding the recommendation, not reciting it.
- SBAR belongs with the interprofessional part of a communication curriculum, alongside I-PASS and TeamSTEPPS, rather than with the patient-facing frameworks.
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Last updated August 2026