You have a patient whose blood pressure is falling. You phone the doctor at 3am, and you have about 60 seconds to make them understand how sick this patient is. SBAR is the tool that makes those 60 seconds count. It was developed in the US Navy and later adapted for healthcare, and it is now used in hospitals from London to Lagos. It also appears in the NMC OSCE, the NCLEX and many job interviews.
What SBAR stands for
| Letter | Meaning | What you say |
|---|---|---|
| S | Situation | Who you are, where you are, which patient, and what the problem is now |
| B | Background | Why the patient is in hospital, relevant history, medications, allergies |
| A | Assessment | Vital signs, early warning score, what you have found and what you think is happening |
| R | Recommendation | What you need: review now, orders, transfer. Ask for a time frame and confirm the plan |
Before you pick up the phone
- Assess the patient yourself, using A–E (Airway, Breathing, Circulation, Disability, Exposure).
- Have the chart, the latest observations, the early warning score, medications and allergies in front of you.
- Know the patient’s resuscitation status and any treatment limits.
- Start any immediate treatment within your scope: sit them up, give oxygen as per policy, stop an infusion causing a reaction.
Example 1: suspected sepsis
S: “Hello, this is Grace, staff nurse on Ward 4. I’m calling about Mr Okafor in bed 12. I’m concerned he may be septic. His NEWS2 score is 7.”
B: “He’s 68, admitted two days ago with a urinary tract infection, and he’s diabetic. He’s on oral antibiotics and has no known allergies.”
A: “His temperature is 38.9, heart rate 118, respiratory rate 26, BP 92/58 (his usual is 140/80), SpO₂ 94% on air. He’s newly confused, and his urine output has been 15 mL an hour for the last three hours. I think he’s developing sepsis.”
R: “I need you to review him within 15 minutes. Could you also prescribe IV antibiotics and fluids? I’ve taken blood cultures and a lactate is pending. Is there anything you’d like me to do before you arrive?”
Example 2: postpartum haemorrhage
S: “This is Aisha, midwife in the labour ward. Mrs Bello in room 3 is bleeding heavily, about 800 mL so far, 20 minutes after delivery.” B: “She’s 32, para 4, with a normal vaginal delivery of a 4.1 kg baby. Her haemoglobin was 10.2 antenatally.” A: “Her uterus is boggy. Heart rate 124, BP 88/50. I’m massaging the uterus and have given the prescribed uterotonic. I think this is uterine atony.” R: “Please come now. I’m calling the obstetric emergency team and requesting crossmatched blood.”
Example 3: a child with breathing difficulty
S: “I’m calling about Tolu, a 3-year-old in bed 5. He’s working much harder to breathe.” B: “Admitted this morning with bronchiolitis, on nasal cannula oxygen 1 L/min.” A: “Respiratory rate 56, intercostal recession, SpO₂ 89% despite oxygen, heart rate 168, and he’s less responsive than an hour ago.” R: “I need a senior review now and I’m concerned he may need escalation to high-flow or HDU.”
Example 4: shift handover
SBAR works for handover too. S: “Mrs Adeyemi, bed 7, day 2 after a hip replacement, stable.” B: “Hypertensive, on warfarin which has been held, with a penicillin allergy.” A: “Observations stable, NEWS2 1, pain 3/10 on regular analgesia, mobilising with a frame, wound clean.” R: “Due her INR check in the morning. The physio is coming at 10.”
Example 5: a medication error
S: “I need to report a medication error for Mr Danjuma, bed 9. He was given a double dose of his evening metoprolol.” B: “He’s 74, admitted with heart failure.” A: “His heart rate is 54, BP 102/64, he’s alert and has no symptoms.” R: “Please review and advise on monitoring. I’ll increase his observations to hourly and complete an incident report.”
Tips that make SBAR work
- Lead with your concern. “I’m worried” or “I think this patient is septic” gets attention.
- Give numbers, not adjectives. “BP 88/50”, not “low BP”.
- Always make a recommendation. Many nurses stop after the assessment. The R is where you ask for what the patient needs.
- Read back any verbal orders and confirm the time frame.
- If you are not satisfied, escalate again up the chain. Patient safety comes before hierarchy.
- Document the call: the time, who you spoke to, what you reported and what was agreed.
SBAR in exams and interviews
In the NMC OSCE, you may be asked to escalate a deteriorating patient. Examiners look for structure, accurate observations, a clear recommendation and documentation. In NHS interviews, “tell us how you would escalate a deteriorating patient” is a common question. Answer with A–E assessment, the early warning score and SBAR.
Related: Normal vital signs and red flags · Sepsis Six · NHS interview questions
Based on the SBAR model promoted by the NHS Institute for Innovation and Improvement and the Institute for Healthcare Improvement. Names in examples are fictional.