How to give a nursing handoff report using SBAR

What SBAR is and where it came from

SBAR stands for Situation, Background, Assessment, Recommendation. The Institute for Healthcare Improvement describes it as an easy-to-remember, concrete way of framing any conversation, especially a critical one that needs a clinician's immediate attention and action. It was developed by Dr. Michael Leonard with colleagues Doug Bonacum and Suzanne Graham at Kaiser Permanente in Colorado, and IHI notes it can be adapted for use with other health professionals.

It was built for conversations that need someone's attention now, such as a nurse calling a physician about a change in a patient, told in an order the listener can follow quickly. The same order works for change-of-shift report, and the Agency for Healthcare Research and Quality builds the verbal part of its bedside shift report checklist around SBAR.

No accreditor requires SBAR specifically. According to AHRQ's Patient Safety Network, the Joint Commission does not recommend a particular handoff tool, but its standard requires that the process give the person handing off and the person receiving a chance to discuss the patient. It also expects the content to cover an assessment of how sick the patient is, a patient summary, a to-do list and contingency plans, delivered face to face whenever possible. If your unit uses its own template, that template comes first; SBAR is a way to order what you say.

This guide describes how to structure a verbal report. It is not clinical guidance, and your facility's handoff policy and tools come first.

What goes in each letter at shift change

Situation. AHRQ's checklist frames it as: what is going on with the patient, and what are the current vital signs? Identify the patient the way your facility requires, then give the reason they are here and the one or two things that define this shift for them. Items your unit always leads with, such as code status and allergies, belong here so they are never buried.

Background. What is the pertinent history? The key word is pertinent. The oncoming nurse can read the chart; what they need from you is the part of the history that explains today, plus anything that changed during your shift.

Assessment. AHRQ's version asks, what is the patient's problem now? PSNet puts it as what you think the problem is. This is where you report what you found and what is worrying you, in plain terms, rather than repeating the chart line by line.

Recommendation. What does the patient need? Here AHRQ's checklist has you go through what is due or pending: labs and tests, medications given, and paperwork still open. Say what needs to happen and by when, and if there is something to watch for, say what to do if it happens. The I-PASS handoff format calls this a contingency plan and suggests an if-then form.

Giving report at the bedside, step by step

1. Introduce the nursing staff to the patient and family, invite them to take part, and open the medical record or the workstation in the room. This sequence comes from AHRQ's Bedside Shift Report Checklist, which the agency adapted from Emory University's bedside report bundle.
2. Give the verbal SBAR report in words the patient and family can understand.
3. Do a focused assessment and a safety check together: look at wounds, incisions, drains, IV sites, tubing and catheters, and sweep the room for hazards. Then review what needs to be done, such as labs, tests, medications given and forms still open.
4. Ask the patient and family about their needs and concerns, and about their own goal for the next 12 hours. AHRQ's checklist stresses that this is the patient's goal, not the nurses' goal for the patient, and suggests checking at the next report whether it was met.

Keeping bedside report short and private

It should not be long. AHRQ's implementation handbook says bedside report should be quick, no more than five minutes. It also notes that nurses who give report at the bedside have reported spending less time on report and managing their time better, because they have seen every patient at the start of the shift.

Some information should not be said in front of everyone. The handbook says bedside report is not the place for bad news or for details the patient or family may not know yet, and suggests sharing that between nurses before entering the room or pointing to it in the chart. Nurses can ask visitors to step out; if the patient asks them to stay, report goes ahead. For a patient who has just fallen asleep, the handbook leaves the decision to the nurse's professional judgment.

Close the loop: let the receiver talk

SBAR on its own ends with the giver's recommendation. The I-PASS format adds a last step, synthesis by receiver, in which the oncoming clinician summarizes what they heard and asks questions. In the I-PASS study published in the New England Journal of Medicine in 2014, a handoff program built around that mnemonic, with training and observation, was followed by a 23 percent drop in medical errors (24.5 to 18.8 per 100 admissions) and a 30 percent drop in preventable adverse events across 10,740 admissions in nine hospitals. That study covered resident physicians and a whole program, not SBAR alone, but the receiver's read-back is easy to borrow.

The evidence for SBAR by itself is thinner than its popularity suggests. A 2018 systematic review in BMJ Open by Müller and colleagues looked at 11 studies and found some evidence that SBAR improves patient outcomes, mostly for nurse-to-physician phone calls, while rating the overall quality of evidence as low. PSNet likewise describes the results as mixed, with better outcomes when SBAR is bundled with other safety measures.

The practical lesson is that the order helps, but the conversation does the work. PSNet notes that effective handoffs need an environment free of interruptions and distractions so the receiver can listen actively and ask questions. Standing at the nurses' station while the call lights go off is the opposite of that.

Common SBAR handoff mistakes

Reading the chart aloud. Background grows until it swallows the report. Keep to what explains today and what changed on your shift.

Recommendations with no action in them. Keep an eye on him tells the next nurse nothing. Say what is due, what is pending, and what to do if a specific thing happens, which is the if-then structure I-PASS recommends.

No room for questions. The Joint Commission standard, as PSNet summarizes it, calls for an opportunity for discussion between the giver and the receiver. A report that ends the moment you finish talking skips that step, so leave time for the receiver to repeat back the plan.

Reporting from memory. The report is only as organized as the sheet it comes from, which is why many nurses keep a brain sheet laid out in the same order they will speak. BrainSheet, for example, shows each patient on one screen in SBAR order at handoff, and you swipe to the next patient while you talk. It is a cheat sheet for the nurse giving report, not a document to hand over, and it has no export or print.

Frequently asked questions