Chapter 3

Using Structure Communication

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 Chapter 3: Using Structured Communication

A key approach to improving patient safety is

improving communication.

This Chapter will focus on understanding where

communication can break down and the tools
that can be used to establish effective
communication.

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 Resources

• Situation Background Assessment

Recommendation (SBAR)
• Concern, Uncomfortable, unSafe, Stop (CUSS)

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 What is effective communication?

Effective communication is an open dialogue, in

which everyone leaves with a shared mental
model

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 Is this effective communication?

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Was the message structured in an easy to follow format?

?
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 Is this effective communication?

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 Understanding why breakdown in communication occurs

• Not including all stakeholders in the

conversation
• Individuals are afraid of speaking up for fear of
blame or having an opinion being dismissed
• Nurses, doctors and other clinicians have all
been taught to communicate in different ways

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 Improving communication takes two forms

Improving the Improving the

message being mechanisms for
communicated communicating

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How do we get everyone to leave with the same message?

The Message

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I
S
B
A
R
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The I-SBAR team
 Key driver

• Communication remains the foundation of

patient safety.
• Numerous reviews of SI indicated poor levels
of communication in the handover of patient
details contributed to the incident
• Improved communication = improved care

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 Aims

• Patients, and families are safe in the hospital

• Patients have timely and equitable access to
services
• Improve the cost and efficiency of care
delivery

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 What is I-SBAR?
• Communication framework- avoid failures in
communication
• Originating from the nuclear submarine service
• Used extensively in medicine
• Safety focused
• Sets expectations
• Teamwork
• Acute clinical situations

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 I–S–B–A–R

• Identify – yourself and the patient

• Situation – what is the problem
• Background –information to contextualise the problem
• Assessment – your clinical assessment and prediction
• Recommendation – what you think should happen
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 Key tasks
• Adapt the SBAR
tool for your
environment

• Test the tool in

the ward
environment

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 I–S–B–A–R–D

• Identify
• Situation
• Background
• Assessment
• Recommendation
• Decision
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 Communicating with who?

Nurses

Doctors

Admin Porter

Patient
Consultant
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 Key tasks

• Develop an education package to train staff in

the use of I-SBAR

• Test the education package

• Implement I-SBAR for nurses and doctors

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 Objectives

• Implement I-SBAR
• Spread I-SBAR across the team
• Spread I-SBAR across the organisation
• Refine I-SBAR training
• Establish I-SBAR as the tool of
communication

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 Process measures

• % of staff trained in I-SBAR

• % always using I-SBAR for critical
communication
• % always including all essential elements in
their report
• % where physician always agrees with
recommendation

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