I used to run EMS. I did it for eight years. We would call report on the radio to the hospital that we were in route to. There is a lot going on in the back of an ambulance so we didn’t have time for “long and elaborate”. We opted for the “short and sweet”. At one of the hospitals I worked at, you had to page the doctor on call for anything you needed. Unlike at level one centers, the doctors have to be available but not actually in house. So imagine having to page at 2:15 in the morning… The doctors where usually tired, angry you paged, and over it before you even picked up the phone to answer their return call. In that moment the docs probably had a two minute attention span so I had better be quick about it. EMS prepared me for the “short and sweet”, the “just the facts ma’am” answer. The doctors seemed to appreciate that.
So what exactly is the SBAR format? How is it beneficial when talking to the doctor in response to a patient?
Situation- What wrong right now? What happened to make you send the page?
Background- What’s been going on with the patient leading up to the event that makes this a change? A little relevant history of the patient is probably good to add too.
Assessment- What have you noticed about the patient in relation to the change you are paging for?
Recommendation- If appropriate, what do you recommend?
I will put SBAR into use so it makes sense, okay?
It is two in the morning in the ICU. My patient starts to ring on the monitor with a heart rate bouncing around from the 120’s to 140’s. It looks super irregular, kind of like A-fib with RVR. I grab the EKG machine and run an EKG on my patient and sure enough, it is. This is new. Time to page the cardiologist… at two something in the morning… and the doc on call is the one with the worst attitude… Great…
He’s on the phone, let’s do this:
Situation- “I’m calling about Ms. S in room 212. She has suddenly flipped into A-fib with RVR from sinus rhythm.
Background- “She is the patient here for sepsis from infected knee hardware who coded in the OR. She converted to A-fib on the monitor about 10 minutes ago and her blood pressure has dropped with it. I looked back and she doesn’t have a past medical history of A-Fib and she’s been in sinus rhythm and sinus tach since admission and she has been here a week.”
Assessment- “I did an EKG and it is showing Afib with RVR. She is still able to follow commands on the vent even though her pressures have dropped from 130’s over 70’s to 90’s over 50’s.”
Recommendation- “Did you want to start her on the amiodarone bolus and then the amiodarone drip? Also, could I go ahead and get an order for a pressor? She hasn’t dropped super low yet but I would rather have the order just in case she does so I don’t have to page you again.”
That’s it. I have had almost this exact conversation with a cardiologist in the middle of the night. It probably took less than three minutes to get all of that out. It was short enough that instead of attitude, I got the orders I wanted. I recommend giving it a shot the next time you have to send a page to the doctor with the attention span of a two year old and the attitude to match!
(of note, please don’t actually say “Situation” and then start talking. You will sound really weird!)