9.2 Interprofessional Collaboration & Communication (SBAR)
Key Takeaways
- Standardized communication frameworks like SBAR reduce errors by providing a predictable structure for critical information transfer.
- TeamSTEPPS tools, including the CUS words and the Two-Challenge Rule, empower all clinicians to stop the line for safety concerns.
- Closed-loop communication (check-backs) is essential during emergent situations to ensure orders are heard, understood, and executed correctly.
- Multidisciplinary rounds (MDRs) leverage the expertise of diverse healthcare professionals to formulate a cohesive, daily patient care plan.
9.2 Interprofessional Collaboration & Communication (SBAR)
In the complex, high-stakes environment of acute care, effective teamwork and communication are essential to patient safety and quality of care. Interprofessional collaboration refers to multiple healthcare workers from different professional backgrounds working together with patients, families, and communities to deliver the highest quality of care. The Adult-Gerontology Acute Care Nurse Practitioner (AGACNP) frequently acts as a central node in this collaborative network, coordinating care among physicians, bedside nurses, pharmacists, respiratory therapists, social workers, and other allied health professionals.
The Impact of Communication on Patient Safety
Communication failures are consistently cited by the Joint Commission as one of the leading root causes of sentinel events in hospitals. Ineffective communication can lead to medication errors, delays in treatment, wrong-site surgeries, and failure to rescue deteriorating patients. The dynamic nature of the ICU or emergency department means information must be transferred rapidly and accurately among team members who may have different mental models of the patient's status. To mitigate these risks, high-reliability organizations adopt standardized communication frameworks derived from aviation and military models.
The SBAR Communication Framework
The most widely recognized and utilized framework in healthcare is SBAR (Situation, Background, Assessment, Recommendation). SBAR provides a structured, predictable method for framing any conversation, especially those requiring immediate clinical action. It eliminates extraneous information, focuses on the core clinical issue, and explicitly states what the clinician needs from the recipient.
| SBAR Component | Description & Focus | Example in Acute Care Escalation |
|---|---|---|
| S - Situation | A concise statement of the current problem. Identify yourself, the patient, and the immediate concern. | "Dr. Smith, this is the AGACNP calling from the CVICU about Mr. Jones in bed 4. My immediate concern is that he has developed acute onset hypotension and severe dyspnea over the last 15 minutes." |
| B - Background | Pertinent clinical history related to the situation. Exclude irrelevant details. | "He is post-op day 2 from a CABG. His last vital signs showed a heart rate of 120, BP 75/40, and oxygen saturation 88% on 4 liters. He received 1 liter of normal saline with no response." |
| A - Assessment | The clinician's analysis of the problem. State what you believe the problem is, or state that you are unsure but worried. | "My assessment is that he is in cardiogenic shock, possibly due to cardiac tamponade given his recent surgery and poor response to fluids." |
| R - Recommendation | What the clinician needs or suggests to resolve the situation. Be specific about timelines. | "I recommend you come to the bedside immediately to evaluate him. I would also like to order an emergent bedside echocardiogram and prepare for possible re-exploration." |
The TeamSTEPPS Framework
Beyond SBAR, the Agency for Healthcare Research and Quality (AHRQ) developed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety). This comprehensive framework provides several tools to improve communication and teamwork.
- CUS Words: A structured escalation technique to get attention when there is a safety concern. CUS stands for "I am Concerned, I am Uncomfortable, this is a Safety issue." Using these specific words acts as a trigger to halt the current action and reassess.
- Two-Challenge Rule: An important safety advocacy tool. If a clinician observes a safety concern, they are obligated to voice it. If the initial concern is ignored, they must voice it a second time, assertively. If the concern is still not addressed, they must escalate the issue through the chain of command (e.g., charge nurse, attending physician, medical director).
- Call-Outs and Check-Backs: Used heavily in emergent situations (like codes). A call-out communicates critical information simultaneously to all team members ("Airway status is secure"). A check-back utilizes closed-loop communication to verify information transfer (Provider: "Give 1 mg Epinephrine IV." Nurse: "Giving 1 mg Epinephrine IV." Nurse: "1 mg Epinephrine IV given.").
Multidisciplinary Rounds (MDRs) and Huddles
Routine structured interactions are vital for proactive care planning. Multidisciplinary rounds (MDRs) are a staple in ICUs. MDRs bring together the entire care team—AGACNPs, attendings, bedside nurses, clinical pharmacists, respiratory therapists, and social workers—to discuss patient progress, review daily goals (e.g., extubation trials, central line removal), and plan for discharge or transfer.
During MDRs, the clinical pharmacist might highlight a drug-renal dose adjustment, while the respiratory therapist provides insight on ventilator weaning parameters. The AGACNP often leads these rounds, synthesizing the specialized input into a cohesive daily plan.
Huddles are distinct from rounds. A huddle is an ad hoc, short (5-10 minute) meeting called to re-establish situational awareness, discuss emerging issues, or debrief after a critical event. For example, if the ICU suddenly receives three trauma admissions, the charge nurse and AGACNP might call a quick huddle to redistribute resources and ensure all patients are safely monitored.
By mastering structured communication tools like SBAR, utilizing TeamSTEPPS strategies to advocate for safety, and actively leading multidisciplinary teams, the AGACNP ensures safe, effective, and collaborative patient care in the high-stakes acute environment.