SBAR

And I give some examples of how that's, that's happened for others as well.

One of the things that I loved at the end of the SBAR is I wrote the tool simultaneously invited deeper reflection on next steps while ensuring that team members didn't feel shut down when offering necessary feedback.

Once a month when I'm prepping for a client call that loves our stuff, but they're worried about how their team will take when I say venting is not helpful.

they say that they've had someone experience RBL somewhere online or at a conference or somewhere, and people say their teams took it as, you can't bring up any issues.

It shuts down all complaints or problems being pointed out, which we've never said ever.

The SBAR helps you point out more problems without all the drama.

You bring your SBAR to point out the four things you're most concerned about and ideas to fix it alongside your leaders.

And so I wanted to put that in the book that this tool is that healthy back and forth of a boundary and not venting where I fix everything as a leader, but you also have endless access to me as long as it's an S bar to flag issues.

This pattern recognition, sudden cessation of output plus hemodynamic decline is the dividing line for elite CVICU thinking.

So what's the SBAR recommendation there?

You are calling the surgeon instantly and you tell the panel you are prepping for a bedside re-exploration.

Wait, really? Like opening the chest right there in the ICU bed?

argue.

Right.

You return with specific SBAR data and ask a respectful question.

It centers everything on the data, not ego.

in one quarter and again a lack of an associated quality improvement plan to address this finding.

There was a general lack of evidence of regular monitoring of compliance with the ISBAR communication tool in one place, limited evidence of regular auditing of compliance with sepsis management protocols and then the result of an audit within an ED in patients where sepsis was suspected there was compliance of only 47.4% with commencing the sepsis form.

So taking together these findings that we've run over in the last few slides under this standard 2.8 really pointed to distinct issues that HICWA, you know, find time and again.

First, where audits simply weren't being conducted and services were losing the ability to actually monitor and evaluate their own performance.

Inspectors found that the national maternity health care record had not been fully adopted in some areas of that hospital.

In another, a lack of deteriorating patient risk register.

In another, the ISBAR communication tool was not being consistently used in practice.

And then finally, in an ED, the emergency medicine EWS hadn't been implemented in practice.

Like someone says, "Hey, do you have a minute?" And they're venting.

Boom, hit it with the SBAR.

It ditches the drama, gets people clean in their thinking.

They go to next right action.

Just consistent use of one tool, we call it the SBAR, deals with 95% of the drama.

Now, I find that fascinating because I know so many groups I work with have had so much leadership training, and the SBAR, which I'll link below if you haven't heard of it, situation, one sentence, background, analysis, recommendations, the tool's also in this book in step five.

It's such a powerful tool, and I- it's always fascinating to me that they're like, "This tool has transformed everything." I'm like, "Haven't you had like six other leadership programs fully rolled out? There's not a tool like that?" And sometimes they say there is, but nobody uses it, but this one seems like it's easier to use.

Whatever it is, I'm grateful, but it's, it's like one tool causes so many breakthroughs.

And this was really fun because I would get to go around and talk to my students and get updates on their patients, and I could see so much transformation with my students.

So what I would be doing is I would be getting an SBAR report on their patient, which is situation, background, assessment, and recommendation.

Recommendation is always, like, kind of like the plan, the plan for what's, you know, what we're doing for this patient today.

It does take a lot of coaching, so don't be sad or upset or freaked out or nervous if your instructor has you do that SBAR multiple times.

It's totally fine.

This is the standard way that we communicate in the medical world.

It's, it's concise, it's, um, very effective, it's very to the point, and so that is why we use it.

So students would either, either give me way too much information, stuff that really wasn't super relevant, or they would skip over things that were super relevant, and then I would have to probe deeper.

Completely gone.

But the story about escalating a mental status change using SBAR, that does not.

It acts as a memory hook, and more importantly, it proves active clinical reasoning.

And then the script brings it all home with the future.

You have written everything down.

You've got your present, past, future structure.

You have your SBAR or closed loop handoff micro story.

You have your three triage personality words ready.

Right.

And the heavy hitter, the one you absolutely cannot survive an ICU interview without, is SBAR.

SBAR.

Yes.

That stands for situation, background, assessment, recommendation.

You confirm they have an airway.

You check their oxygen, and you check their pulse and rhythm.

And then the candidate had to actually vocalize the SBAR.

We all have worked as nurses in different settings in healthcare, and nurses are naturally skilled and good at communication.

We learn strategies like SBAR, Situation Background Assessment Recommendation.

Nurses every day are communicating in their places of work, oftentimes with patients who are sick and often need education, or perhaps with new nurses they're teaching or mentoring.

And they're communicating with non-nurses as well and non-patients, so clinical roles and non-clinical roles.