Irritated MDs: to SBAR or not to SBAR?

[Melanin]

When I was new at my hospital, I called an MD and after identifying the patient about whom I was calling I didn't give a complete SBAR, because I guess the MD seemed to indicate at the beginning of our conversation that he was familiar with the patient, so giving an SBAR just seemed awkward and wierd. After I explained the reason for my call, the MD had me transfer the phone to the charge nurse - then he went off on me because I hadn't started off my conversation with a proper SBAR, and the CN had to have a big talk with me, and I was made to feel like I'd committed a pretty huge transgression.

Fine. Lesson learned. Skip ahead about a year in time.

Now, I find that MDs sometimes get irritated with me for starting off with the SB part of SBAR - nothing long and involved, just an "I'm calling about Mr. so-and-so, a fifty year old male admitted three days ago for shortness of breath related to lung cancer" kind of thing. Just today, the MD on the other line was like, "why are you telling me about this patient? He is my patient, and I know him."

I said, "I'm just trying to give a proper report."

"But why must you tell me all these details about my patient?"

"Because," I said, "I'm trying to give a proper SBAR so that I don't get yelled at for not giving SBAR."

(I probably shouldn't have added that part about getting yelled at, but there you go.)

I know that we're all pressed for time, because me, I'm SO pressed for time every minute of the day. I don't give SBAR because I love it, or because I enjoy talking to MDs so much that I want to prolong my phone call by a precious minute - I do it because it's our protocol, and because I've gotten in trouble for NOT doing it, and because I can't always intuit how familiar the MD is with that patient or how readily they'll recall the patient simply from hearing the patient's last name.

I wonder if I should bother speaking to the MDs about what they really want (consensus, anyone?), or it I should just chill out and know that I'll never really know for sure & that's life.

[Castiela]

I ask if the physicians are familiar with the patient before going into background aspect. If they are, I'll skip ahead. If not, then I'll include it

[kaylee.]

Thats interesting, yeah i rarely do a full sbar because all the docs know the patient...but sometimes if its a covering and its kindof a detailed call, describing a chain of events, i will start with, "this is dr jones pt, are u familiar with him?” Just if some background is needed...

I also think the docs are really on top of knowing these days. Because back in the day the only place to learn about the pt was the physical chart at the station. Now they can even access at home, so i think they do their homework...computers have helped alot.

[amoLucia]

Not only is SBAR a method with which you communicate info to another health care professional, it also provides you a specific disciplined approach for you to gather that info and then relay it.

It should be getting you into the habit of how to collect important data in a defined, systematic way. You won't waste your time or that of the other provider.

[canoehead, BSN, RN]

The original physician was a passive aggressive douche. Why didn't he ask you questions rather than complaining to the charge nurse about it? Why didn't the charge nurse recognize that, and tell him that his questions could easily be answered buy the RN that made the original call?

SBAR is a tool, not one of God's commandments. If you just finished talking to the physician about the patient an hour ago, chances are that they will remember the situation if you need to ask another question. Of course, if you call that physician that complained again, SBAR the hell out of him.

[JKL33]

^ That's sort of what I was going to say too, although my words were "You should have ignored the first doofus." You say you were new, so I understand why that experience made such an impression.

Phone calls to physicians can be made and nursing reports can easily be given without yet another acronym. As far as I'm concerned it's another reinvention of the wheel.

[Melanin]

I sometimes get caught between what the managers keep harping on us to do, as opposed to what makes sense at the time. In meetings, managers love to bring up MD complaints about nurses who aren't consistently giving SBAR, but it sounds like SBAR is situation-specific.

[Scottishtape]

I had to learn the docs. I don't give SBAR to the docs that are always on our floor that I know they are familiar with the patient.

I will, however, give SBAR to consults or specialists, because I find usually, they aren't as familiar with the patient.

That helped me a lot when trying to figure out when to use it and when not to.

It's also helpful to just ask at the beginning.

"I'm calling about the patient in rm X. Are you familiar with this patient?" And continue from there.

[LibraSunCNM, BSN, MSN, CNM]

I sometimes get caught between what the managers keep harping on us to do, as opposed to what makes sense at the time. In meetings, managers love to bring up MD complaints about nurses who aren't consistently giving SBAR, but it sounds like SBAR is situation-specific.

That's a familiar dilemma for floor nurses, and certainly for new ones. Some great advice has been given here already, but in a nutshell: you'll learn over time how to approach each interaction with MDs. When in doubt, if you err on the side of caution by giving a full SBAR, you really did nothing wrong except possibly waste a few seconds of the MD's time. If they're going to get bent out of shape about that, they are probably either exhausted, or just generally unreasonable people. Either way, not really your problem, so let it roll off your back (the ability to do that will also take time).

[Ddestiny, BSN, RN]

I've never had a physician even mention SBAR....Sounds like he really was being a passive-aggressive douche. Especially if he's now going back and complaining about it both ways.

Since there is a sense of urgency in anything done in healthcare, even a quick phone call to ask for an update or an order, I will start my call with "This is Ddestiny, I am calling about Smith in Room 4 to request PO pain medication orders now that he is no longer nauseated." I've literally never had any problems/complaints from this. If I know the physician hasn't seen the patient yet (i.e. was just admitted or consulted but I'm needing orders I'll give a bit more info "I know you haven't met Smith in Room 4 yet, but I am needing _____ for his ____" and then I field any questions. I always have my "brain sheets" with me when I call so I'm able to tell them what they need to know but I don't spout it off before I tell them why I'm calling.

The only communication complaint I've ever had from a physician was when I would ONLY refer to the patient by their room numbers, certain hospitalists don't keep track of the room number. So that is why I now usually use room number and last name when it's not a potential privacy violation issue (i.e. in another patient's room).

[MunoRN, RN]

If I'm talking to an intensivist who's been dealing with the patient all day then I skip the background except for info they may not be aware of related to the situation, otherwise I go into the background until the physician conveys they are aware of the background. Part of the problem is that different physicians want information fed to them differently, and for some reason they assume all other physicians have the same preferences and therefore we should always know what they are. The most concerning thing is that your charge nurse sided with the physician, when the CN should have just reminded the physician that if they want more background they just need to ask for more background, ie "use your words".

I've found part of the problem is that nursing has an unhealthy obsession with SBAR, and it's not used for situations for which it was never intended such as shift to shift report, which then morphs it into something defeats the true purpose of SBAR; to be a short, concise description of a single issue.

[cleback]

I've never had a physician even mention SBAR....Sounds like he really was being a passive-aggressive douche. Especially if he's now going back and complaining about it both ways.

Since there is a sense of urgency in anything done in healthcare, even a quick phone call to ask for an update or an order, I will start my call with "This is Ddestiny, I am calling about Smith in Room 4 to request PO pain medication orders now that he is no longer nauseated." I've literally never had any problems/complaints from this. If I know the physician hasn't seen the patient yet (i.e. was just admitted or consulted but I'm needing orders I'll give a bit more info "I know you haven't met Smith in Room 4 yet, but I am needing _____ for his ____" and then I field any questions. I always have my "brain sheets" with me when I call so I'm able to tell them what they need to know but I don't spout it off before I tell them why I'm calling.

The only communication complaint I've ever had from a physician was when I would ONLY refer to the patient by their room numbers, certain hospitalists don't keep track of the room number. So that is why I now usually use room number and last name when it's not a potential privacy violation issue (i.e. in another patient's room).

I don't think I've given a true sbar in years. All of our providers are linked to our emr, so to say "Mr whoever is a 60 yo male here for shortness of breath" would be not efficient as all that would be clearly listed in the medical chart they're pulling up. Maybe I'm thinking of it in the wrong way but I've never had a provider make a complaint.