Handover: Using SBAR So Nothing Falls Through the Gap

Handover is where information is most likely to be lost, and it is repeatedly implicated in serious incidents. The failure is rarely that someone did not care. It is that unstructured handover loses the same components every time: how sick the patient is, and what the person handing over actually wants done.

At a glance

Situation

Identify yourself, your role and where you are calling from. Identify the patient. Then state the problem in one sentence, and state how unwell they are early, because that determines how the receiver listens to everything that follows. “I am worried about this patient” is not a soft phrase — it is information, and it should be said in the first few seconds if it is true.

Background

This is the part that runs long. The discipline is to give only what the receiver needs to interpret the current situation: the reason for admission, the relevant history, what has been done so far, and what has changed. A chronological retelling of the whole admission buries the point.

Assessment

Say what you think is happening. Interns often skip this because they feel unqualified to have an assessment, and that instinct is understandable but wrong: you are the person who has just seen the patient, and your impression is data. If you do not know, say that explicitly — “I do not know what this is, but they look worse than they did an hour ago” is a completely legitimate and highly informative assessment.

Recommendation

This is the part most often missing, and its absence is what turns a handover into a conversation with no outcome. Say what you want to happen and in what timeframe. Do you want them to come and see the patient now? Within the hour? Do you want advice on a drug? Do you want a scan requested? Do you want permission to do something?

Be explicit about urgency in words rather than tone. “Please can you come and see them now” and “please can you review them when you are free” are different requests, and a receiver on a noisy phone cannot reliably infer which one you mean.

Confirming the message landed

Ask for a read-back of the plan, or give one if you are receiving. It takes seconds and it catches the misunderstandings that would otherwise surface hours later. Then document that the handover happened, to whom, at what time, and what was agreed.

Handing over a shift rather than a patient

The same structure applies, with two additions. First, actively flag the patients you are worried about rather than letting them sit in list order — an unwell patient buried in the middle of a list is functionally not handed over. Second, hand over the jobs that are outstanding and the results that are pending, because a result nobody is waiting for is a result nobody will see.

What can go wrong

What seniors actually ask

• What do you want me to do?
• How sick are they, in your judgement?
• What are the observations, and what is the trend?
• Have you told the nurse looking after them?

Last-minute checklist

• Identify yourself, the patient, and the problem in one sentence
• Say how unwell they are in the first few seconds
• Background limited to what is needed to interpret the situation
• Give an assessment, even if it is “I do not know, but they look worse”
• State explicitly what you want and by when
• Ask for or give a read-back
• Document who, when, and what was agreed

References

• Your hospital’s handover policy and escalation protocol
• Institutional guidance on structured communication tools