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Improving Hospice Communication Using SBAR

"Effective communication is the cement that binds an organization together. It is the foundation upon which successful teamwork and good customer relationships are built," according to Connie Podesta, an expert in the psychology of human behavior and leadership development. In health care, good communication is vital in order to center services on patient needs.

The number one problem with communication is that often the sender of the message believes that the receiver of the message understands it one way when that is actually not what occurs — the receiver hears a different or incomplete message. We all recall playing the game of "telephone" at camp, with the message starting out in the first ear ending up like nothing that is heard in the last ear of a giggling camper.

According to the Joint Commission on Accreditation of Healthcare Organizations, miscommunication is the most common cause of patient injury or death. Many of the untoward events we have in the medical world today are the result of communication failures.

One communication tool that has been adapted by many hospitals and now home health agencies is the SBAR tool. The SBAR is known as the Situation Briefing Model. The acronym represents S-Situation, B-Background, A-Assessment, and R-Recommendation. The tool’s adaptation to the health care setting was spearheaded by Kaiser Permanente of Colorado. The SBAR originated in the United States Navy Nuclear Submarine Service, which needed a means of communication that was brief and effective.

This method of communicating can certainly benefit the hospice providers who "just by the nature of our service" spend a lot of time contacting the patient’s physician via telephone. In home health, the tool was specifically introduced to help assist in reducing unnecessary hospitalizations in the Centers for Medicare & Medicaid Services Home Health Outcome-Based Quality Improvement initiative. Hospices such as the Visiting Nurse Service of New York have also taken a look at SBAR.

Whether our communication is external or with other members of the Hospice Interdisciplinary Group, using a structured means of communication will improve efficiency and safety. To be successful with SBAR, your agency should follow the SBAR process:

  • (S) Situation: Describe the situation you are calling to report.
  • (B) Background: Give the physician (or team member) pertinent background information related to the situation.
  • (A) Assessment: Relay the clinician’s assessment of the situation to the physician (or team member).
  • (R) Recommendation: Recommend what action you would like the physician (or team member) to take, such as a change in level of care, an extra nurse visit, a change in medication, etc.

Document the change in the patient’s condition, the physician notification, and coordination of care.

It is important to note that the situation should be described in no more than 5-10 seconds. Remember physicians only want to hear the significant data to get to the resolution. So be accurate and concise with information.

Because the Hospice Conditions of Participation require coordination of care both internally and externally, the SBAR tool may also be useful for the management of effective, efficient communication related to patient situations.

§418.56(e) Standard: Coordination of services

L554: The hospice must develop and maintain a system of communication and integration, in accordance with the hospice’s own policies and procedures, to:

(4) Provide for and ensure the ongoing sharing of information between all disciplines providing care and services in all settings, whether the care and services are provided directly or under arrangement.

Surveyor Probes §418.56(e)

  • What systems are in place to facilitate the exchange of information and coordination of services among staff and with other non-hospice health care providers?
  • How does the hospice ensure that coordination of care occurs between services provided directly and those under arrangement?
  • Is there documentation in the clinical record of the sharing of information between all disciplines providing care and with other healthcare providers furnishing services to the patient?

Remember that effective communication is the foundation to patient safety, comfort and quality of care, which is the basis of why we do what we do.

For a complete SBAR tool kit with scenarios and practice scenarios for staff visit

http://www.qualitynet.org/dcs/ContentServer?cid=1157485259584&pagename=Medqic%2FMQTools%2FToolTemplate&c=MQTools.

If your hospice has successfully implemented SBAR as a communication tool, please email

cindymorgan@homeandhospicecare.org to share your story.

For more information about this article, please contact Cindy Morgan of AHHC of NC at 919.971.8731 or cindymorgan@homeandhospicecare.org.

© 2014 Poyner Spruill LLP. All rights reserved.

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Poyner Spruill  is a 115 attorney multidisciplinary law firm, with offices in Raleigh, Charlotte, Rocky Mount, and Southern Pines, North Carolina, giving it a statewide presence. The firm’s size enables it to foster individual attorney excellence in such diverse practice areas as bankruptcy, workouts, creditors’ rights, employment law, commercial real estate, employee benefits, banking law, venture capital, public utilities, health care law, governmental relations, environmental law, securities law, municipal law, construction law, white collar criminal defense, as well as...

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