Question

please i need SBAR for normal abdominal examination thank you

Answer 1

SBAR defined

The prevailing gold standard handoff structure, Situation, Background, Assessment, Recommendation (SBAR), was originally developed and effectively used during submarine duty handoff by the US Navy. The Joint Commission describes the SBAR communication technique as, Situation: what is the situation; why are you calling the physician? Background: what is the background information? Assessment: what is your assessment of the problem? Recommendation: how should the problem be corrected? In a health care setting, the SBAR protocol was first introduced at Kaiser Permanente in 2003 as a framework for structuring conversations between doctors and nurses about situations requiring immediate attention. SBAR was originally implemented in health care settings with the intent of improving nurse-physician communication in acute care situations; however, it has also been shown to increase communication satisfaction among health care providers as well as their perceptions that communication is more precise. The role of the SBAR tool during handoff has been highlighted and supported by various specialties such as anesthesia, perioperative medicine, postoperative medicine, obstetrics, emergency medicine, acute care medicine, pediatrics, and neonatology.

Example of SBAR tool in a clinical setting

An RN on the pediatric floor has an order for a child to have fluids by mouth as he is admitted with vomiting and abdominal pain. Initially, the patient has pain in the periumbilical area and now it is radiating to the right lower quadrant. The ordering physician needs to be called to review the patient’s condition and clarify the order regarding fluid intake.

Situation: “Dr. Gill, this is Nancy on the Pediatric floor, I have an order for clear fluid intake for little Jonny who is in room 420 with abdominal pain, I would like to update you regarding Jonny’s condition and clarify orders with you.”

Background: “I see that Ronny was admitted through the Emergency Department with abdominal pain and vomiting. His abdominal pain has gotten worse and now radiating to right lower quadrant. Oral fluids were ordered for him.”

Assessment: “Ronny looks unwell as his abdominal pain has increased and he has been throwing up more since he was admitted.”

Recommendation: “I think we should keep him nil per os (NPO) and give him intravenous fluids. Do we need to arrange ultrasound to rule out appendicitis?”

A fundamental part of physical examination is examination of the abdomen, which consists of inspection, auscultation, percussion, and palpation. The examination begins with the patient in supine position, with the abdomen completely exposed. The skin and contour of the abdomen are inspected, followed by auscultation, percussion, and palpation of all quadrants. Depending on the findings or patient complaints, a variety of examination techniques and special maneuvers can provide additional diagnostic information.

Comparison of SBAR with other communication tools

There are few studies that have looked into the comparison of SBAR with other tools to assess communication during a handoff in a health care setting. Horwitz and colleagues developed an easy-to-remember mnemonic SIGN-OUT (Sick, Identifying Data, General Hospital Course, New Events of the Day, Overall Health Status, Upcoming Possibilities with Plan, Task to Complete Overnight with Plan) tool for medical house staff. SIGN-OUT was compared by in-house physicians to SBAR using pretest and posttest self-reported attitudes following an hour educational session. Perceived comfort with providing SIGN-OUT increased (mean score from 3.27 ± 1.0 to 3.94 ± 0.90; p < .001). SIGN-OUT was ranked as important or very important to patient care by all participants and was rated as useful or very useful by all participants. SIGN-OUT received a slightly higher rating than SBAR.

Ilan et al. performed a study using the video recording of patient handoff in an academic ICU in Canada to describe handoff communication patterns used by physicians in the ICU setting and to compare this with currently popular, standardized schemes for handoff communication. Forty individual patient handoffs were randomly selected by attending physicians. Two independent coders reviewed handoff transcripts, documenting elements of three communication tools: SBAR, SOAP (Subjective, Objective, Assessment, Plan), and MAN (Medical Admission Note). This study shows that the majority of handoff content consisted of recent patient status and the recommendation component of the handoff was missing in 50% of the handoffs. Elements of all three standardized communication tools appeared repeatedly throughout the handoff without any consistent pattern. The author concluded that ICU physicians do not commonly recommend communication tools during handoff and likely these tools do not fit the clinical work of handoff within the ICU setting due to the complexity of the cases.