Using the ISBAR Method for Successful Handovers.
Introduction
When transmitting information about a patient to a new person/team within the healthcare system, a handover is thus performed. A handover is best described as sharing specific details about a patient to someone else. When done right, it allows a lot of information to be passed down quickly and effectively, which can be challenging. They occur in numerous places around the hospital and are commonly performed, be it when: patients arrive at the hospital (from the ambulance in ED), being admitted or consulted by staff, during shift changeovers, handover to ward call, ward call reviewing on a night shift, handing over to nursing staff after ward rounds, escalating to a consultant, inter-hospital transfer, theatre time-outs, discharge summaries or referral letters, and so on.
An ISBAR is a recognised and effective method to deliver handovers practically to another person/team. The ISBAR is simple, quick-to-use, memorable and portable. It is designed to have a logical, structured approach in providing concise and easy-to-understand information, making communication more effective and streamlined.
About 70-80% of medical errors are related to communication errors or problems with interpersonal interaction, especially between teams. As well as being related to malpractice claims, poor communication harm patients and make work-life unnecessarily tricky. In addition, the more there are handovers, the more chance of having errors occurring. Hence, becoming skilful in creating a reliable handover using the ISBAR method is crucial.
ISBAR for handovers
Before starting with an ISBAR, here are some tips to increase your success in making an effective handover:
Make sure you have all the information in front of you (such as investigations, results, notes and so on). Sit in front of the computer if you have to.
Stay relaxed and calm; it can be difficult and annoying when the person you are talking to is distracted. Always be polite as it can be helpful; politeness takes you to places further and more efficiently. Don't forget your thank you!
Be clear about what you need at the start of the phone call.
How detailed the handover differs from situations and staff. The depth and breadth need to be tweaked.
It is always appreciated when you ask if there is anything you can do in the meantime.
Practise all the time as it is a complex and daunting skill. Always ask for advice from friends and colleagues. Document your conversation whether you have been helped or not, and seek advice from a senior staff member if you have to.
INTRODUCTION
Introduce yourself.
Name, position, where you are calling from.
Check who you are calling.
SITUATION
What is happening at the moment? Involve a couple of sentences that should inform quickly about the current situation.
Introduce the patient (name, DOB/UR, age, sex, location).
Provide the timing of the current problem.
What do you want? (review, consult, advise). Make it very clear in the area you wish to be informed on and the patient's management. Mention a possible diagnosis if you have one.
BACKGROUND
This section provides the patient's overview, including the most relevant details. The appropriate information changes from person to person, situations, specialities, teams, etc.
Date of admission.
Presenting complains.
Ongoing diagnosis and other current issues/complications.
Relevant pst medical and past surgical history.
Relevant medication/allergies.
Results of the necessary investigation (bloods, imaging).
Intervention to date (any surgeries, fluids, Abx), ceiling of care. What is their current management, and how are they going?
ASSESSMENT
Assessment regards the objective clinical evaluation of the patient.
Vital signs: oxygen saturation, pulse (rate, character and volume), blood pressure, respiration rate, temperature.
Clinical examination findings: provide acute and relevant baseline findings. DRS ABCDE may be helpful in this context.
Overall diagnosis and clinical impression (including trajectory).
RECOMMENDATION/RESPONSE & REVIEW
What should be done to correct this situation? Giving your recommendation about what should be done in managing the patient as well as hearing what advice the other person is recommending.
State your plan/recommendation: the ongoing diagnosis, what needs to happen, and the plan and management time frame.
Ask the advisor: if/when they will review the patient and their given time frame. Whether there is anything further you can do or reasons to escalate. Whether the patient needs to be transferred, such as ICU, theatre, etc.
If you are unsure, it is okay to say, "I am unsure of the diagnosis and/or the next step in the management, I am concerned, and your input is greatly appreciated."
Has the advisor understood the situation, and do they have any further questions?
Clarify the expectation of the response.
Document the discussion.
Stay polite and thank them for their busy time.
Published 15th January 2022. Last reviewed 25th March 2022.
Reference
Clinical Governance Hunter New England Health. ISBAR revisited: Identifying and solving barriers to effective clinical handover. NSW health. https://www.safetyandquality.gov.au/sites/default/files/migrated/ISBAR-toolkit.pdf. Reviewed May, 2009. Accessed March 1, 2022.
Dr Francine Cheese. SBARR Communication - Communication skills. Geekymedics website. https://geekymedics.com/sbarr-communication/. Updated November 12, 2021. Accessed March 1, 2022.