What SBAR Stands For
SBAR is a structured way of passing on information about a patient. The letters stand for:
- Situation: what is happening now, and why you are calling
- Background: the clinical context the listener needs
- Assessment: what you think is going on
- Recommendation: what you want to happen next
The tool was developed from a communication technique used by the US Navy and adapted for healthcare by Kaiser Permanente in the early 2000s. It is now used widely across the NHS, and NHS England publishes an SBAR communication tool for staff. Most trusts build it into their handover sheets and escalation policies.
Why Handover Needs a Structure
Handover is the moment when responsibility for a patient moves from one professional to another, and it is a well-known point of risk. Information gets left out or remembered wrongly, and urgent concerns can sound routine. A shared structure helps with each of these. The speaker knows what to say and in what order, and the listener knows what to expect and can spot what is missing.
SBAR also helps with hierarchy. Nurses, particularly newly registered nurses and nurses new to the UK, can find it hard to tell a senior doctor that a patient needs to be seen now. Because the Recommendation is a set part of SBAR, stating what you need is part of the structure, so you do not have to find your own way of asking.
Each Part in Detail
Situation
Identify yourself, your ward and the patient, then state the problem in one or two sentences. The listener should know within the first few seconds why you are calling.
Some trusts use ISBAR, which adds an Identify step at the start for your name, role and location. The content is the same and only the label differs.
Background
Give the context the listener needs to understand the problem: the reason for admission, relevant history, current treatment, allergies and recent results or observations. Keep it relevant. A full history slows the call down and buries the important points.
Assessment
Say what you think is happening. This is the part nurses most often leave out, and it is the part that shows clinical judgement. A list of observations is data. An assessment interprets the data: "I think he is deteriorating and I am concerned about sepsis." If you are not sure what is wrong, say so and say why you are worried, as that is still an assessment.
When you are escalating a deteriorating adult, include the NEWS2 score here. Under the Royal College of Physicians' NEWS2 guidance, an aggregate score of 5 or 6, or a score of 3 in any single parameter, triggers an urgent response. A score of 7 or more triggers an emergency response.
Recommendation
State what you are asking for and how soon: a review within a set time, a specific investigation or a change to the plan. Then agree what happens next, including what you will do in the meantime and when you will escalate again if nothing changes.
A recommendation is a request for action. Nobody expects a nurse to make a medical diagnosis.
A Worked Example: Escalating a Deteriorating Patient
The patient in this example is fictional.
Situation: "This is Anna, staff nurse on Ward 7. I am calling about Mr A in bed 12. His NEWS2 score has risen to 7 and I am concerned he is deteriorating."
Background: "He is 72 and was admitted three days ago with community-acquired pneumonia. He is on IV antibiotics. His NEWS2 was 2 at 08:00. He has no known drug allergies."
Assessment: "His respiratory rate is 24, oxygen saturation is 93% on room air, heart rate is 105, blood pressure is 104 systolic and temperature is 38.4. He is alert. I think his chest infection is getting worse and I am worried about sepsis."
Recommendation: "I need you to review him now. Would you like me to take blood cultures and a venous blood gas, and start oxygen, while you come? I will repeat his observations in 15 minutes and call the outreach team if his score goes up."
The NEWS2 parameter scores here are 2 for respiratory rate, 2 for saturations, 1 each for heart rate, systolic blood pressure and temperature, and 0 for consciousness and for breathing air. That makes 7, which is the emergency threshold, so the Recommendation asks for review now. Your trust's escalation policy sets out exactly who to call and how fast.
Closing the Loop
SBAR covers what the speaker says. The listener has a part too. When you receive an instruction, especially a verbal order, repeat it back to confirm you have understood it correctly. This is called read-back or closed-loop communication. Then document the call: who you spoke to, when, what you reported and what was agreed.
SBAR at Shift Handover
SBAR was designed for escalation, but the same structure works for routine shift handover, bedside handover, transfers between wards and referrals to other teams. At shift handover the Recommendation usually becomes the outstanding tasks: observations due, results to chase, medicines to review and concerns for the next shift to watch. Many trusts use a written SBAR template for transfers so the same information travels with the patient.
How SBAR Links to the NMC Code
The NMC Code does not mention SBAR by name, but several of its standards describe what SBAR is for. Section 7 asks you to communicate clearly. Section 8 asks you to work cooperatively, including sharing information with colleagues. Section 13 asks you to recognise and work within the limits of your competence, which includes recognising worsening health and referring on in good time. If you want a refresher on how the Code is organised, see our guide to the four principles of the NMC Code.
How SBAR Questions Tend to Look
Questions on SBAR are usually scenario-based. Common forms include:
- A handover script with one element missing, where you identify which one
- A choice between several opening lines, where you pick the clearest Situation
- A deteriorating patient with a NEWS2 score, where you choose the most appropriate Recommendation
- A question about what the receiving nurse should do with a verbal instruction
The way to get these right is to know what belongs in each section and to recognise when the urgency in the Recommendation does not match the Assessment. For more on the exam itself, see the NMC CBT format explained.
Practise SBAR Questions
SBAR Handover is a topic in Module 2 of NMC Prep, alongside escalation of the deteriorating patient. You can find it on the Communication, Teamwork and Documentation module, which is part of the paid plan. Module 1, Professional Practice and the NMC Code, is free with no card required, so you can try the question format there first.