Prehospital SBAR Handover

You have spent forty minutes with a patient. You know how they looked when you arrived, what changed, what you tried, what the relative said in the hallway, and what is worrying you. The person receiving them gets about thirty seconds of that, in a room with three conversations happening, while looking at a monitor rather than at you.

Studies of information retention at handover are sobering: a substantial proportion of what is said is not retained, and structure improves it. The structure is not the point in itself — the point is that a structure lets the listener know what is coming, which is what makes recall possible.

If you want to practise giving one under pressure, run a case that ends in a handover.

Which structure, and does it matter

SBAR — situation, background, assessment, recommendation — is the general-purpose structure, and it exists in a dozen local variants. Trauma handovers commonly use a mechanism-first structure instead, because in trauma the injury pattern is the organising fact.

The evidence for structured handover as a category is reasonable; the evidence for any one acronym over another is not. Which means the practical answer is straightforward: use whatever your service and receiving units use, consistently. A structure everyone in the room recognises outperforms a better structure that only you know.

What matters much more than the choice is three habits that apply to all of them.

The four things that actually get remembered

Regardless of acronym, a handover succeeds if four pieces of information land. Build your version around these and the rest is detail.

1. Who this is and how sick they are. Age, the one-line problem, and your assessment of severity in plain terms. "This is a sixty-one-year-old who I think is septic and is deteriorating" orients the room in eight words. Leading with the mechanism of a fall from twenty minutes ago does not.
2. The trajectory. Better, worse, or unchanged, and over what period. This is the most frequently omitted and most clinically valuable item, because it is the one thing the receiving team cannot obtain for themselves. They can repeat every observation you took; they cannot know what the observations were an hour ago.
3. What you did and what it changed. Not a list of interventions — interventions plus response. "Gave oxygen, saturations came up to 96 and the work of breathing settled" is clinically informative. "Oxygen on" is a task record.
4. What you want. The recommendation. Explicitly.

Why the recommendation gets dropped, and why it must not

The final letter of SBAR is the one most often skipped, and there is a recognisable reason: stating what you want can feel like overstepping, particularly when handing over to someone more senior.

It is not overstepping, and omitting it costs time. A recommendation is not a demand; it is a statement of your clinical concern converted into an actionable form. "I think this patient needs to be seen in the next few minutes rather than waiting" is a piece of clinical information that only you possess, because only you have seen the trajectory.

Three formulations that work, in increasing directness:

• "My concern is that he is still deteriorating." — states the worry without prescribing.
• "I think this needs a senior review now." — states the requested action.
• "I am not happy leaving this patient in the corridor." — states a boundary, appropriate when the first two have not landed.

And if you are uncertain, say that too. "I do not know what this is, and I am worried about him" is one of the most useful sentences in acute medicine. It is far more informative than a confident diagnosis you do not actually hold.

Handing over by radio or satellite

Remote handovers — to a receiving hospital by radio, to a telemedicine service by satellite phone, to a retrieval team over a poor line — change the constraints substantially, and habits from face-to-face handover transfer badly.

You cannot rely on being interrupted. In a resus room, the listener asks the question you skipped. On a marginal satellite link, they may not, and you will not always know whether they heard you. So the front-loading matters more: severity and the question you are asking come first, before the history.

Say the number, then say what it means. Numbers survive a bad line poorly and get transposed. Say "respiratory rate thirty — three zero — which is up from twenty" for anything that would change a decision.

Ask for a read-back of the decisive figures. Drug names, doses, and any number that drives a decision. It feels laborious and it catches errors that are otherwise found hours later.

Write it before you say it. This is the biggest difference. For a scheduled advice call or an evacuation request, spend two minutes filling in a written structure first. You get one attempt at a call that may be difficult to re-establish, and reading from a prepared page is dramatically more complete than improvising.

State what you are asking for, separately from what you are reporting. Remote clinicians receive a lot of description and not always a question. "I am asking whether to start treatment now or wait for the next set of observations" tells them what to answer.

Practising it

Handover is the most frequently performed and least rehearsed skill in acute care. Three rehearsals that work.

Say it out loud before you arrive. On the way in, compose the handover aloud. You will notice the gaps while you can still fill them, which is the entire benefit.

Give one to a colleague and have it read back. Not a critique — a recall test. What they repeat back is what actually landed, and the gap between what you said and what they retained is usually instructive.

Practise the version you dread. Handing over a patient you are worried about, to someone who seems unconvinced, with an explicit recommendation. That is the handover that matters and the one nobody rehearses.