Handoff and SBAR communication

What it is

A handoff (or hand-over) passes the information about a patient, and responsibility for their care, to someone else. It happens at shift change, on transfers between units, on arrival in recovery and at discharge. Communication failures at these moments are a frequent cause of adverse events. WHO recommends a standardised handoff, such as SBAR (Situation, Background, Assessment and Recommendation), enough time to ask questions without interruptions, and repeat-back or read-back of key information. Some institutions use the ISBARR variant, which adds an introduction at the start and repeating back orders at the end.

What it requires

• A common format, such as SBAR, reduces confusion.
• Enough uninterrupted time to ask and answer questions.
• Repeat back and read back critical information.
• Keep the handoff to what is needed for safe care.
• Involve the patient and family, to the degree they choose.

Components

• Current condition and recent changes.
• Medications and treatments in progress.
• Devices: lines, tubes, drains and oxygen.
• Pending items: results, procedures, consultations.
• Risks: falls, pressure injuries, allergies, isolation.
• Advance directives and the patient's wishes, if any.

How it is applied (and why)

1. Prepare first: assess the patient and review orders, notes and results — you arrive with data, not doubts.
2. Introduce yourself and say where you are calling from — the listener knows who is speaking and from which unit.
3. S: give the patient's name, location and the specific reason — this focuses the conversation from the first sentence.
4. B: give only the relevant background, including allergies — this saves time without leaving out what is critical.
5. A: share your findings and what you think is happening — this adds your clinical judgment, not just loose data.
6. R: ask for something specific with a time frame, such as seeing the patient now — the call ends with a clear action.
7. Read back the orders you receive and wait for confirmation — this prevents misunderstandings.
8. Record the communication, the time and who was told — this leaves a record and keeps care continuous.

SBAR example of a call to the doctor (made-up data)

In nursing practice

• In a bedside handoff, the outgoing and incoming nurses check the patient, devices and risks together.
• If visitors are present or the room is not private, confidentiality is protected during the handoff.
• On transfer to another facility the handoff is more detailed and usually uses a checklist.
• At discharge, the patient and the next care provider must know the diagnosis, plan, medications and pending results.

Common mistakes

• Calling without having assessed the patient or reviewed the record.
• Telling the whole history before saying what is happening now.
• Ending the call without a specific request.
• Accepting a verbal order without reading it back.
• Handing over in the corridor, with interruptions and without seeing the patient.
• Not recording who was told and when.

Test yourself

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Connections

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Communication During Patient Hand-Overs (Patient Safety Solutions, vol. 1, solution 3) (World Health Organization, WHO Collaborating Centre for Patient Safety Solutions, 2007); Nursing Fundamentals (Open RN), 2.4 Communicating with Health Care Team Members (Open RN, Chippewa Valley Technical College (LibreTexts), 2022); Nursing Management and Professional Concepts (Open RN), 3.2 Communication (Open RN, Chippewa Valley Technical College (LibreTexts), 2022).

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Representative model, for educational purposes only.