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Patient Hand Off Tool Kit
Public Information Educational Resource Committee
SBAR-Situation Background Assessment Recommendations
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Problem
An estimated 80 percent of serious medical errors involve miscommunication between caregivers when patients are transferred or handed-off.
http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf
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Universal Process across disciplines
SBAR is an evidenced-based communication model developed in the military and is widely used in many industries including aviation and health care to make sure:
the right information gets to the right people in the shortest timeframe
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These guidelines outline the priority information that needs to be relayed during patient care handoff to the receiving healthcare provider so that critical information is not missed.
SBAR-Situation Background Assessment Recommendations
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SBAR-Situation Background Assessment Recommendations
This format emphasizes urgent concerns be brought to the forefront –Patients who meet Point of Entry protocols –should have complaint stated first
Empowers the EMS provider to advocate for the patient
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SBAR-Situation Background Assessment Recommendations
These guidelines are to be used in a flexible way that meets the needs of the situation encountered
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Region IV EMS Communication Policy is based on SBAR
Situation: ETA Urgent Concerns/ Point of entry pts Age Sex Chief Complaint:Background: (history of present illness) High Risk medicationsAssessment: General impressions Pertinent findings Vital signs Pain level Recommendations/Recap
Treatment provided Response to treatment and interventions Recap
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Massachusetts EMS Region IV Communications Policy
Entry NotesHail Metro-Boston CMED on MED 4
CMED name x 2 Service, call sign, current level of ambulance Reason for request (Priority Level, Medical Control, ALS
entry note, BLS entry note, declaration of disaster, radio test)
Physical Location
•For Example: “Metro-Boston-CMED, Metro-Boston-CMED. This is Bedford A-2 requesting a priority one BLS entry note to the Lahey from Route 62 in Bedford”
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Massachusetts EMS Region IV Communications Policy
Await channel assignment from Metro-Boston CMED (ie “Shift and acknowledge MED 3”)
Once a channel has been assigned, shift to that channel and acknowledge CMED standing by. (ie “Metro-Boston CMED, Bedford A-2 standing by on MED 3”).
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Massachusetts EMS Region IV Communications Policy
Metro-Boston CMED will advise unit that the requested hospital(s) are on-line and for them to proceed with their transmission.
Make the entry note as clear, concise, and short as possible
Rule of thumb, no more than two minutes Immediately request notification of Stroke,
Cardiac, Trauma team, or other specialty services (language, vent required, etc..) if appropriate (following Point of Entry Protocols (POE)
When reporting a patient’s condition, the radio report should include the following - SBAR Format
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Massachusetts EMS Region IV Communications Policy
When provider has completed entry note:
Provider should acknowledge hospital(s)
Inform Metro-Boston CMED you are leaving the assigned MED channel and returning to MED 4
Relinquish the assigned MED channel to CMED on MED 4
Transmit Call sign and time clearing assigned channel
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How SBAR works….S State agency name and unit #
Point of Entry* or High Risk pt*-ETA- age and sex of the ptUrgent concerns and immediate needs upfront
B Mechanism of Injuries sustained/LOC/or Onset of illnessInclude complicated medical hx and or High Risk medications
A Vital Signs – and pertinent findings
R Treatment and patient responseRecapRequest any further instructions
Point of Entry- Trauma Adult/Pedi, Stroke, STEMI, SepsisHigh Risk Meds – anticoagulants (Coumadin,Plavix,Aspirin ect)
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Let’s practice!
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EMS Scenario (Example 1)
You have responded to a home for a report
of elderly female unwitnessed fall.
An 88 year old female is found on the floor, awake-
Family states heard “thud” found pt on floor –report no LOC,
Pt complaining of left hip and shoulder pain.
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EMS Scenario (Example 1)
Left lower extremity is rotated outward, has a positive pedal pulse, warm to the touch-pink in color
Left shoulder without obvious deformity, Color Sensation normal, states-“hurts to move my left arm”
Past Medical History: osteo arthritis CVA, a-fib
Medications: Coumadin, Digoxin
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EMS Scenario (Example 1)
Pt was placed in a cervical collar-log rolled onto back board and pillows to support LLE
Secured on backboard- ice to shoulder
Pt states uncomfortable on the board, but the ice helps
Vital Signs: B/P-172/88 HR-58(irr) Resp-18
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SBAR Report…..
(assume you have Hailed CMed - and patched into receiving facility…you have identified your unit #... Proceed
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Entry Note (should take no more than 2 minutes-following the region IV
policy)
Situation: ETA – 17 min Urgent Concerns/ Point of entry pts : Elderly
Trauma Age - 88 Sex – female Chief Complaint: Fall with left hip and shoulder
painBackground: (history of present illness-) Unwitnessed fall, Found on floor- left leg and
shoulder pain, family reports no LOC, pt is on Coumadin for A fib and Stroke
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Entry Note (should take no more than 2 minutes-following the region IV policy)
Assessment:* General impressions: Elderly conscious female Pertinent findings: Alert- left leg rotated
outward-+ pulses, left shoulder pain-no obvious deformity
Vital signs: B/P-172/88 HR-58(irr) Resp-18 Pain level: Rates pain 5/10 Recommendations/Recap*
Treatment provided - C-spine immobilized, ice to shoulder, immobilized LLE
Response to treatment and interventions – pain improved with immobilization and ice
Recommendations – Will update with any changes-any questions?
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Emergency Department Arrival “Hand Off”
Situation: Urgent Concerns/Point of entry pts : Elderly
Trauma Age - 88 Sex - female Chief Complaint: Fall with left hip and shoulder
pain
Background: (history of present illness-detailed history)
Unwitnessed fall, Found on floor- left leg and shoulder pain, family reports no LOC, pt is on Coumadin and Digoxin for A fib and Stroke
States tripped and fell-alert to baseline per family
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Emergency Department Arrival “Hand Off”
Assessment:* General impressions: Pleasant elderly
female Pertinent findings: Alert- left leg rotated
outward-left shoulder pain no deformity, warm pink and pulses in both extremities- No c/o neck or back pain-
Vital signs: B/P-172/88 HR-58(irr) Resp-18 Pain level: Rates pain 5/10
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Emergency Department Arrival “Hand Off”
Recommendations/Recap:* Treatment provided - C-spine
immobilized, ice to shoulder, immobilized LLE
Response to treatment and interventions – pain improved with immobilization and ice –pt states she in uncomfortable on the backboard
Recap- no changes enroute
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SBAR- Interfacility Transfer
Expectations for “Hand Off” from : Acute Care Facility Rehabilitation Facilities
Skilled Nursing Facility or Community Health Center
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SBAR-Situation Background Assessment Recommendations
Situation: Urgent Concerns Age Sex Chief Complaint Background: History of present illness – Include Resuscitation Status (MOLST -
Medical Orders for Life Sustaining Treatment) http://www.molst-ma.org/ Comfort Care DNR
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SBAR-Situation Background Assessment Recommendations
Assessment: General impressions Pertinent findings Vital signs Pain level Recommendations/Recap: Treatment provided Response to treatment and interventions
Recap
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Scenario Example #2 You are called to a Skilled Nursing Facility-
you receive the following report from the staff:
Mr. Jones is an 76 male- transferred 1 week ago from XYZ hospital s/p left knee replacement. For the past few days he has become increasing more fatigued and agitated
He is not eating well and has intermittent fevers
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SBAR- Interfacility Transfer
Situation: Urgent Concerns –change on
mental status Age- 76 Sex - male Chief Complaint :fever change in
mental status
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SBAR- Interfacility Transfer
Background: History of present illness – 2 weeks s/p left knee replacement-
2 days hx of intermittent fevers- 99.5- 102.3
today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated
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SBAR- Interfacility Transfer
Assessment: General impressions: lethargic, warm
to the touch-combative with stimulation
Pertinent findings-temp 102.3, decreased urine output, tachypnic
Vital signs – HR 102, B/P 112/60, R-28 Temp 102.3
Pain level- 5/10 flank pain
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SBAR- Interfacility Transfer
Recommendations/Recap: Treatment provided-acetaminophen
and called EMS Response to treatment and
interventions- no change at this time
Recap – 76 m, altered mental status- confused-agitated, 2 week s/p left knee replacement - fever no response to acetaminophen
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SBAR- Interfacility Transfer
EMS transports to closest appropriate emergency department
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Let’s practice!
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SBAR- Interfacility Transfer Entry Note (should take no more than 2 minutes-following the region IV
policy)
Situation: ETA – 20 min Urgent Concerns/ Point of entry pts :
n/a Age - 76 Sex – male Chief Complaint: fever- change in
mental status
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SBAR- Interfacility Transfer
Background: (history of present illness-)
2 weeks s/p left knee replacement – 2 days hx of intermittent fevers-
99.5- 102.3 today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated
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SBAR- Interfacility Transfer
Assessment:* General impressions: Ashen in color-
lethargic, warm to the touch-combative with stimulation-
Pertinent findings: increased agitation with bilateral flank palpation, l knee wound site dry and intact, patient incontinent with foul urine-
Vital signs: HR 102, B/P 112/60, R-28 Temp 102.3
Pain level: 5/10 flank pain
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SBAR- Interfacility Transfer
Recommendations/Recap* Treatment provided – 2L Oxygen via nasal cannula ,
position of comfort Response to treatment and interventions – no
changes
Recommendations – Will update with any changes-any questions?
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Emergency Department “Hand Off”
Situation: Urgent Concerns/Point of entry pts : Age - 76 Sex - male Chief Complaint: fever- change in
mental status
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Emergency Department “Hand Off”
Background: (history of present illness-)
2 weeks s/p left knee replacement – 2 days hx of intermittent fevers-
99.5- 102.3 today lethargic, confused and agitated- generally alert and oriented today-sleeping not eating, agitated
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Emergency Department “Hand Off”
Assessment:* General impressions: Ashen in color-
lethargic, warm to the touch-combative with stimulation-
Increased agitation with bilateral flank palpation, left knee wound site dry and intact, patient incontinent with foul urine-
Vital signs: HR 102, B/P 112/60, R-28 Temp 102.3
Pain level: 5/10 flank pain
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Emergency Department “Hand Off”
Recommendations/Recap* Treatment provided – 2L Oxygen via nasal cannula ,
position of comfort Response to treatment and interventions – no
changes
Do you have any questions?
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SBAR-Situation Background Assessment Recommendations
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Thank you
References:
http://www.centerfortransforminghealthcare.org/assets/4/6/CTH_HOC_Fact_Sheet.pdf
http://www.mbemsc.org/files/provider_info_items/Entry_NotesApproved_MADPH_OEMS_2_3_10.doc
http://www.psnet.ahrq.gov/resource.aspx?resourceID=4195
Contra Costa EMS