Table 3.

Effect of SBAR on clarity of communication

Author, year	Study design	SBAR training	Objective of communication	Measure of quality of communication	Reported results	Relative improvement (qualitative size)
Classroom-based studies
Cunningham et al 201225	RCT	10-min didactic session explaining the SBAR method of clinical handover and its application in telephone referrals immediately prior to test scenario	Contacting senior member of staff via telephone (medical or surgical registrar) to refer a medical patient with chest pain or surgical patient with abdominal pain	Implicit assessment: ability ‘to get the message across’ as measured by 4-point scale for poor, fair, good or excellent as judged by a senior clinician reviewing 66 audio recordings, with a second clinician independently reviewing 30%	SBAR exposure: 3.0 versus control: 2.0 on 4-point scale, p=0.003	50% (Large)
Marshall et al 200926	RCT	40-min ISBAR training (including role-playing) for 17 teams of medical students learning how to communicate in telephone referrals to more senior physicians	Contacting senior colleague via telephone for assistance with management of an unstable trauma patient in high fidelity simulation centre	Explicit assessment: clarity and delivery of communication as measured by rating referral according to the presence of elements of quality (eg, coherence, conciseness, etc) as judged by senior clinician reviewing 17 video and audio recordings (a second clinician reviewed first half to ensure adequate agreement)	SBAR exposure group had higher score on 5-point scale for clarity as measured by Spearmen rank correlation (r=0.903), p=0.001	N/A (large based on r statistic >0.5)
Uhm et al 201927	Controlled before–after	4-hour SBAR training (including role-playing) embedded in 1-week practicum for nursing students for various nurse-physician communications	Notifying physician about patient’s status of bronchiolitis with desaturation or acute gastroenteritis with severe dehydration	Explicit assessment: clarity of communication according to presence of elements of quality (eg, coherence, conciseness, etc) as judged by two investigators independently reviewing 81 audio recordings	SBAR exposure: 29.9 versus control: 22.4 on 40-point scale, p<0.001	33% (Moderate)
Studies in clinical setting
Randmaa et al 201629	Controlled before–after	SBAR Implementation and 2.5-hour training (including role-playing) for nurses and physicians for nurse–nurse communication at rounds or shift change and nurse–physician communication at rounds or handover	Nurse–nurse communication at rounds or shift change and nurse–physician communication at rounds or handover	Explicit assessment: percentage of recalled information sequences by receivers as measured by counting identified sequences from 164 audio recordings and observations	SBAR exposure: 43.4% to 52.6% - (↑ 9.2%) Control: 51.3% to 52.6% - (↑ 1.3%) Not significant (p value not reported)	18% (Small)
Shahid et al 202047	Uncontrolled before–after	Implementation of a modified SBAR tool and didactic training with videos for 10 nurses for nurse–physician communication during interfacility neonatal transports	Neonatal transport cases	Implicit assessment: global rating score as measured by rating the quality of the handover using 165 audio recordings	3.0 to 3.9 on 5-point scale, p<0.001	30% (Moderate)
Smith et al 201835	Uncontrolled before–after	SBAR-DR implementation and 30-min didactic training with videos and demonstrations for 68 physicians in emergency department for physician–physician telephone communication at admission handover	Physician–physician telephone communication at admission handover	Implicit assessment: global rating score as measured by rating on an anchored scale using 220 audio recordings	2.9 to 3.1 on 5-point scale, p=0.236	5% (Small)
Vlitos and Kamara 201651	Uncontrolled before–after	Implementation of a modified SBAR tool and training (including role-play) for nurses for nurse–physician communication between ward staff and physicians on duty	Contacting physician on duty via telephone for triaging cases	Explicit assessment: percentage of physicians given adequate information to safely triage cases measured using 103 audited calls	58% to 84%, p value not reported	45% (Large)
Wilson et al 201737	Uncontrolled before–after	SBAR implementation with reminder tools and full-day training (including role-playing) for nurses-physician-respiratory therapist communication during interfacility neonatal and paediatric transports	Paediatric transport cases	Explicit assessment: integration of content as measured by scoring on tool for related items using 187 audio recordings	7.3 to 8.4 on 10-point scale, p<0.001	16% (Small)
				Implicit assessment: global rating score as measured by rating the handover using 187 audio recordings	3.4 to 3.9 on 5-point scale, p<0.001	15% (Small)

ISBAR, identification of self followed by SBAR; RCT, randomised controlled trial; SBAR, situation, background, assessment, recommendation; SBAR-DR, Situation, Background, Assessment, Responsibilities & Risk, Discussion & Disposition, Read-back & Record.