The SBAR Handover

The SBAR handover is the only part of the IMT interview with its own domain and its own clock: one minute at the end of station 2, weighted 0.8. It is the easiest mark to lose and the easiest to rehearse.

Key takeaways

• NHS England describes SBAR as situation, background, assessment and recommendation, and as a structured way of communicating information that requires a response from the receiver.
• The same guide says SBAR can be used to escalate a clinical problem that requires immediate attention, or to facilitate efficient handover of patients between clinicians or clinical teams.
• NHS England and NHS Improvement's Quality, Service Improvement and Redesign tool says the SBAR tool originated from the US Navy and was adapted for use in healthcare by Dr M Leonard and colleagues at Kaiser Permanente in Colorado.
• The Royal College of Physicians defines handover as the system by which the responsibility for immediate and ongoing care is transferred between healthcare professionals, in Acute care toolkit 1, published May 2011 and currently under review.
• That toolkit cites Bhabra and colleagues' 2007 study: over five handovers, only 2.5% of the information from the first handover is retained at the end if there is no written record, rising to 85.5% if notes are taken and 99% when a standardised proforma is used.
• GMC Good medical practice 2024 paragraph 65 says you must be confident that information necessary for ongoing care has been shared before you go off duty, before you delegate care, or before you refer the patient on.

What is the principle behind a structured handover?

The principle behind a structured handover is that responsibility, not just information, is being transferred, and the transfer has to be explicit for it to have happened at all.

The Royal College of Physicians states it directly. Handover is the system by which the responsibility for immediate and ongoing care is transferred between healthcare professionals.

Its toolkit records why the system fails. Failure in handover is a major preventable cause of patient harm, principally due to the human factors of poor communication and systemic error, causing delayed decisions, repeated investigations and incorrect treatment.

NHS England makes the same point about escalation. Inadequate verbal and written communication is recognised as being the most common root cause of serious errors, both clinically and organisationally.

What does each letter of SBAR contain?

Each letter of SBAR has prompts NHS England sets out explicitly, and a handover that answers all four in order is the whole technique.

• Situation: identify yourself and the site or unit you are calling from, identify the patient by name and the reason for your report, and describe your concern, including location, resuscitation status and vital signs.
• Background: give the reason for the patient's admission, explain significant medical history, and give the admitting diagnosis, date of admission, prior procedures, current medications, allergies and pertinent laboratory results.
• Assessment: give the vital signs and your clinical impressions and concerns. NHS England's own examples include 'I think she may have had a pulmonary embolus' and 'I'm not sure what the problem is, but I am worried'.
• Recommendation: explain what you need, be specific about the request and the time frame, make suggestions and clarify expectations. Its example is 'I would like you to come immediately'.

Name the fifth step, which candidates almost always miss. NHS England adds readback: after any SBAR communication, the receiver reads back a summary of the information in the same SBAR format, to make sure it was understood.

Why does SBAR help a junior doctor in particular?

SBAR helps a junior doctor because it supplies the sentence that hierarchy makes hardest to say. NHS England says SBAR prevents the hit and miss process of hinting and hoping.

The same guide says SBAR is an effective way of levelling the traditional hierarchy between doctors and other care givers by building a common language for communicating critical events.

The Quality, Service Improvement and Redesign tool adds that SBAR is particularly effective where staff may be uncomfortable about making a recommendation, for example because they are inexperienced or are speaking to someone more senior.

Say that out loud in a station about escalation. The reason you are being asked to make a recommendation is precisely that recommendations are the part junior doctors leave out.

What is the worked one-minute handover, said aloud?

Here is a worked SBAR handover of a deteriorating patient, said the way you would say it at the end of station 2.

Situation. This is Alex, the IMT1 on the acute medical unit. I am calling about Mrs Patel in bay 4. I am worried she is septic: her news score is 9, she is tachycardic at 124 and her blood pressure is 88 over 54.

Background. She is 71, admitted yesterday with a community-acquired pneumonia, on intravenous co-amoxiclav, with a background of type 2 diabetes and chronic kidney disease. She was stable this morning.

Assessment. I think she has severe sepsis with acute kidney injury. I have taken cultures and a lactate, which is 4.2, started oxygen and given a 500 mL fluid challenge, and her urine output is 15 mL in the last two hours.

Recommendation. I need you to review her within the next fifteen minutes, and I would like your view on whether she needs critical care. In the meantime, shall I repeat the lactate and give a further fluid challenge?

That is under a minute, it names the ask and the time frame, and it ends with a question that invites readback rather than a pause that invites silence.

What else does a good handover contain?

A good handover contains an explicit transfer of responsibility and a prioritised list, not just a patient summary. The Royal College of Physicians toolkit names both.

• Define who is relinquishing responsibility and who is now responsible for ongoing care, including the scope of that responsibility and the specific tasks.
• Standardise the systems of communication, for example SBAR, both verbal and documented, with repetition to confirm shared understanding.
• Define the immediacy of review by the incoming team using a red, amber, green patient risk assessment, where red is haemodynamic or respiratory instability, unclear diagnosis or sepsis; amber is a response to prescribed treatment that requires close monitoring; and green is stable and discharge planned.
• Ensure that the handover is communicated effectively to the patient and, where relevant, to family and carers.
• Combine a standardised written proforma with a face-to-face verbal handover, which is what the toolkit recommends.

GMC Good medical practice 2024 paragraph 65 adds the professional duty. You must promptly share all relevant information about patients with others involved in their care, and check where practical that a named clinician or team has taken over responsibility when your role has ended.

What does the panel listen for in a handover?

The panel listens for whether your handover has an ask. The handover is scored as its own domain at the IMT interview, weighted 0.8, and a one-minute summary with no recommendation cannot score well.

• That you identify yourself, the patient and the reason in the first sentence.
• That you give numbers rather than adjectives: the observations, the lactate, the urine output, the times.
• That you say what you think is going on, even as uncertainty, rather than listing findings.
• That you name what you want and by when.
• That you invite readback or confirmation rather than trailing off.
• That you stay inside the minute, which means selecting rather than reciting.

Remember what else is being marked. Communication in station 2 is weighted 1.6, so the handover minute is scored twice over: once as handover and once inside the communication domain.

What is the trap in the one-minute handover?

The trap in the one-minute handover is starting at the beginning of the admission. Candidates re-present the case from the front door and run out of time before the recommendation.

The second trap is the missing ask. NHS England's whole case for SBAR is that staff hint and hope instead of making a recommendation, and the recommendation is the only part the receiving clinician can act on.

A third trap is false certainty. NHS England explicitly offers 'I'm not sure what the problem is, but I am worried' as a legitimate assessment, and a candidate who invents a diagnosis to sound decisive is doing the less safe thing.

A fourth is handing over information without handing over responsibility. If nobody has said who is now responsible and by when they will attend, the handover has not happened.

How do you escalate if the handover does not work?

If a handover or escalation does not produce action, repeat the recommendation with the time frame, then go up the chain, and say so plainly in the station.

• Restate the ask and the deadline explicitly, and ask the receiver to read back what they have understood.
• Escalate to the medical registrar, then the consultant on call, then critical care outreach, and say you would document each attempt with the time.
• Use the workplace's own escalation policy, which GMC Good medical practice 2024 paragraph 72 expects you to be familiar with and to use.
• Where patient safety may be seriously compromised, paragraph 75 requires you to act promptly rather than continue to monitor.

Saying that patient safety outranks hierarchy, and then giving the concrete next telephone call, is what a panel is listening for in an escalation answer.

How this comes up at the IMT interview

At the IMT interview, the SBAR handover is the final minute of station 2. The station is a clinical scenario of up to ten minutes on investigations, diagnosis and management, then a one-minute handover of the same patient.

It is its own scored domain, weighted 0.8, which is the lowest weighting in the interview and the easiest to rehearse to a score of 5, because the structure is fixed and the content is the case you have just discussed.

internalmedicineinterview's bank of 361 IMT questions across 56 scenarios includes handover practice with AI-marked spoken answers, for £97 to the end of the 2027 interview window, so you can hear whether you made the ask inside the minute.