What is SBAR and why is it used in handover?
Handover is the moment responsibility for a patient, or part of their care, passes from one person or team to another. It happens at shift changes, ward transfers, ambulance arrivals and every time you ask a colleague to review someone. Each one is a chance for information to be lost.
SBAR gives handover a predictable order. It began in the US Navy and was adapted for healthcare by clinicians in the United States, and it is now used across the NHS. The speaker knows what to say next, and the listener knows what to expect. It works for a two-minute phone call and for a full shift handover.
SBAR template: what goes in each part?
| Part | What to include | Prompt phrases |
|---|---|---|
| Situation | Your name and role, where you are, the patient, and the problem in one sentence | "This is... I'm calling about... I'm concerned that..." |
| Background | Reason for admission, key conditions, recent procedures, current treatment, allergies, escalation and resuscitation status | "They were admitted with... They're on... They're for full escalation" |
| Assessment | Observations, NEWS2 and its trend, relevant results, what you have seen, and what you think is happening | "NEWS2 is... up from... I think they are..." or "I'm not sure what's wrong but I'm worried" |
| Recommendation | What you want the listener to do, and by when, plus what you should do meanwhile | "I need you to review them within... Would you like me to...?" |
Situation: lead with the problem
The most common mistake is starting with a long history, so the listener only learns why you are calling at the end. Put the problem in the first sentence. If you are worried, say so plainly. "I am concerned" is a powerful phrase.
Background: relevant, not everything
Give the history that helps explain the current problem. Have the notes, drug chart and observation chart in front of you so you can answer questions.
Assessment: data, then judgement
Give objective findings first, then your impression. You do not need a diagnosis. A clear statement that you do not know what is wrong but are very worried is a valid assessment and should be acted on.
Recommendation: be specific
"Could you have a look when you get a chance?" is not a recommendation. "I need you to review him within 15 minutes" is. You can also suggest actions and ask what the listener wants you to do in the meantime.
SBAR example for nurses: escalating a deteriorating patient
"Hi, it's Ward 9. I've got Peter in bed 4, he came in a couple of days ago with pneumonia, he's got COPD and diabetes, his daughter said he's not himself, and his obs are a bit off. Could you pop up at some point?"
"Hi, this is Mariam, staff nurse on Ward 9. I'm calling about Peter in bed 4. I'm worried he's becoming septic. He's 76, admitted two days ago with pneumonia, on IV antibiotics, with COPD and type 2 diabetes, and he's for full escalation. His NEWS2 is 7, up from 3 at eight this morning. Resp rate 27, sats 87% on 2 litres, BP 94 over 56, heart rate 121, temperature 38.7, and he's newly confused. I need you to review him within 15 minutes. Shall I take bloods, cultures and a gas while you're on your way?"
The weak call has no clear concern, no data and no time frame, so it is easy to deprioritise. The strong call names the worry first, gives the score and its trend, and asks for a specific response.
SBAR examples for doctors, physiotherapists and paramedics
Doctor to registrar
"Situation: it's Sam, FY1 on the surgical take. I'm calling about Carol in bay 2, day one after a bowel resection. I think she may have an anastomotic leak. Background: she's 64, otherwise well, on regular analgesia, for full escalation. Assessment: new severe abdominal pain, heart rate 128, BP 102 over 64, temperature 38.4, lactate 3.1, abdomen rigid. Recommendation: I'd like you to see her now. I've sent bloods and cultures and started fluids. Do you want a CT arranged before you arrive?"
Physiotherapy handover
"Doreen in bay 5 didn't do well today. She'll probably need more help."
"Situation: handing over Doreen in bay 5, day two after a knee replacement. She couldn't stand today, and I'm concerned about pain and possible delirium. Background: independent with one stick before admission, lives alone. Assessment: drowsy and muddled this afternoon, pain 8 out of 10 on movement, unable to weight-bear safely with two staff. Recommendation: please review her analgesia and screen for delirium before tomorrow's session, and keep her on hoist transfers until reassessed."
Ambulance handover in the emergency department
Paramedics often use ATMIST (Age, Time, Mechanism, Injuries, Signs, Treatment) for trauma and SBAR for medical patients. The receiving team should listen without interrupting for the first minute, then ask questions. For example: "Situation: this is Jean, 79, sudden right-sided weakness and slurred speech. Background: last seen well at 10:15 by her daughter, takes apixaban for atrial fibrillation. Assessment: FAST positive, glucose 6.8, BP 182 over 98, GCS 14. Recommendation: suspected stroke within the time window, she needs the stroke team and imaging now."
Community nurse to GP
The GP cannot see the patient, so be especially clear. "Situation: I'm Femi, district nurse, with Harold, 86, at home. I'm worried he has a new chest infection. Background: COPD and heart failure, and his care plan says he prefers treatment at home. Assessment: resp rate 24, sats 88% on air against his usual 92%, temperature 38.1, more breathless than two days ago. Recommendation: I'd like a GP to assess him within two hours to discuss antibiotics or admission."
How do you use SBAR for a shift handover?
- Protect the time: Hand over in a quiet place at a set time, with bleeps held by someone else where possible. Interruptions are a major cause of lost information.
- Prioritise: Start with unwell or deteriorating patients, then those with outstanding tasks or results, then stable patients.
- Make tasks explicit: Say what is outstanding, who owns it and by when, for example: repeat potassium due at 22:00, check and act per the chart.
- State escalation plans: Include resuscitation status, treatment escalation plans and any agreed ceilings of care.
- Check understanding: The receiver asks questions, summarises key actions and reads back critical numbers such as doses and results.
- Document: Record the handover in line with local policy, including outstanding tasks and who has accepted them.
How should you receive an SBAR handover?
Receiving handover is an active job. Read-back means repeating key information to the sender, who confirms it. It matters most for verbal instructions, phone results, doses and numbers. For example: "So you'd like 500 mL of sodium chloride 0.9% over 15 minutes, blood cultures and a lactate, and repeat obs in 30 minutes. Is that right?"
- If no recommendation is given, ask for one: "What would you like me to do, and by when?"
- If you are unsure, ask. Silence is not agreement.
- If a plan seems unsafe, say so clearly.
- Do not assume you know the patient. Ask about allergies and escalation status if not given.
Common barriers to good handover, and fixes
| Barrier | What helps |
|---|---|
| Hierarchy: reluctance to call a senior, or a concern dismissed | Use SBAR with clear words of concern. If not satisfied, escalate again or to the next level |
| Interruptions and noise | Protected handover time, quiet space, bleeps held |
| Time pressure | Prioritise the sickest patients and use the structure so essentials are not skipped |
| Language and accent differences | Speak clearly, avoid slang and abbreviations, use read-back |
| Assumptions | State the obvious, including allergies and escalation status |
| No recommendation | Always end with what you need and by when |
Divya is a nurse recently arrived from overseas. At 02:30 a post-operative patient's NEWS2 rises from 2 to 6 with a heart rate of 126. She bleeps the doctor: "Sorry to bother you, bed 8's obs are a bit up, could you see him sometime?" The doctor is at an emergency and plans to come later. By 04:30 the patient is hypotensive with internal bleeding and returns to theatre, then recovers. In reflection, Divya recognised she gave no concern, score or time frame, felt reluctant to bother a senior, and did not escalate to the nurse in charge or outreach when the doctor did not come. She practised SBAR calls with her practice educator and now jots the four headings down before every call.
A good record of that call might read: 02:35, NEWS2 6 (from 2 at 22:00), HR 126, BP 104/68, RR 22, sats 95% on air, pale, abdominal pain. SBAR call to FY1, review requested within 30 minutes. Advised 30-minute obs, FBC and group and save. Read back confirmed. To escalate to registrar if not reviewed by 03:05.
Making SBAR a habit
Before you pick up the phone, write the four headings and a few words under each. It takes under a minute. See the patient yourself, have the charts to hand and know the escalation status. After the call, document the time, who you spoke to, the plan and when you will escalate further if needed. Professional standards for doctors, nurses, midwives and allied health professionals all expect clear communication and prompt action when safety is at risk.
Our course SBAR Handover Training covers each part of SBAR, weak and strong examples across ward, emergency, community and maternity settings, read-back and barriers, with reflective prompts. For a closer look at phone conversations, see our guide on escalating a patient over the phone.
Frequently asked questions
What does SBAR stand for?
SBAR stands for Situation, Background, Assessment and Recommendation. It is a structured way to hand over or escalate a patient so the listener quickly understands the problem, the relevant context, your findings and exactly what you need them to do.
What is an example of SBAR in nursing?
"This is Mariam on Ward 9 about Peter in bed 4. I'm worried he's becoming septic. He's 76, admitted with pneumonia, for full escalation. NEWS2 is 7, up from 3 this morning, BP 94 over 56, newly confused. I need you to review him within 15 minutes."
What is the difference between SBAR and ISBAR?
ISBAR adds Identify at the start, prompting you to identify yourself, your location and the patient before stating the situation. SBAR usually includes this within the Situation step. Some organisations also use SBARR, adding Read-back or Response. Use whichever format your organisation has adopted.
What should the recommendation in SBAR include?
A specific request and a time frame, such as "please review within 15 minutes". You can suggest actions, such as bloods or fluids, and ask what the listener wants you to do in the meantime. A vague request like "when you get a chance" is easy to deprioritise.
Can SBAR be used for shift handover?
Yes. Use it for each patient, starting with the sickest, and focus on what has changed and what needs doing. Make tasks explicit with a named owner and a time, include escalation status, and have the receiver read back critical information.
What is read-back in handover?
Read-back means the person receiving information repeats the key points to the sender, who confirms or corrects them. It is especially important for verbal instructions, doses, numbers and results given over the phone, because mishearing is common in busy settings.
What NEWS2 score should trigger escalation?
Under the Royal College of Physicians' NEWS2 chart, an aggregate score of 5 or 6, or a single parameter scoring 3, needs an urgent response, and 7 or more needs an emergency response. Your organisation's escalation policy sets out who to call, and clinical concern alone is always a valid reason to escalate.
Related courses
SBAR Handover Training
This course teaches you to use SBAR (Situation, Background, Assessment, Recommendation) for clear, structured handover and escalation. It shows how…
Breaking Bad News Training (SPIKES)
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Sources and further reading
- SBAR implementation and training guide. NHS England (NHS Institute for Innovation and Improvement).
- National Early Warning Score (NEWS) 2. Royal College of Physicians.
- Suspected sepsis in people aged 16 or over: recognition, assessment and early management (NG253). National Institute for Health and Care Excellence.
- Good Medical Practice (2024). General Medical Council.
- The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Standards of conduct, performance and ethics. Health and Care Professions Council.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
More guides
The SPIKES Protocol for Breaking Bad News, With Example Conversations
The SPIKES protocol for breaking bad news explained step by step, with example conversations, useful phrases, common mistakes and what to do afterwards.
How to Handle Difficult Conversations With Patients and Families
How to handle difficult conversations with patients and families: calming anger, the NURSE approach, apologising, complaints, disagreement and safe boundaries.
How to Escalate a Patient Over the Phone: A Clear Structure That Works
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