I have been known to outdistance a voice messaging tape or two. And in my early case management years, I was so passionate about some of my cases that I was known to go the long haul in "communicating" to others. Slowly, I realized how annoying this was. But after all, nurses and physicians are trained to communicate differently: nurses are trained to communicate by being descriptive, detailed, and narrative (better not "diagnose!!"); physicians are trained to summarize, diagnose, and fix things. It is no wonder we have communication gaps.

This journal often highlights effective communication techniques-and most recently focused on "Crucial Conversations." These two very different techniques (SBAR and Crucial Conversations) are used for very different reasons. Crucial Conversations is worth its weight in gold when you find yourself in a situation where the stakes are high, and so are the emotions. SBAR, on the other hand, is an effective situational briefing system that provides a practical roadmap to succinct, important, but brief communication.

SBAR stands for the following (Joint Commission on Accreditation of Healthcare Organizations, 2005):

Situation: What is the situation you are calling/communicating about?

Background: What is the background or context?

Assessment: What do you think the problem is?

Recommendation: What would you do to correct it?

After a brief introduction identifying yourself and your purpose for the call or encounter, you may use the SBAR technique in the following way:

Situation: Mr. MacDuff is a Medicare patient who came into the emergency department (ED) with complaints of chest pain. In the ED, his findings from cardiac markers, electrocardiogram, and chest radiograms were normal. He was admitted to telemetry for further workup.

Background: He states that his chest pain has been on-and-off for over a week, starting from after his Thanksgiving festivities. He has a history of asthma, pneumonia, and gastroesophageal reflux disease.

Assessment: On Day 2, the findings from a stress test were also normal. I do not think Medicare will consider this inpatient admission appropriate.

Recommendation: I would like to change his status from inpatient to observation. I will have to initiate a form called a "code 44," which will correct his admission status.

One question you may ask yourself before embarking on an SBAR conversation is, "Am I sharing relevant, timely, and important information?" The receiving end should not be thinking, "Tell me something I don't know."

SBAR can be an effective hand-off tool when a case manager is transferring a patient to another case manager, another unit, or another level of care. By using a shared model (such as SBAR) situational awareness of complex information during hand-offs is enhanced (Haig, Sutton, & Whittington, 2006). The hand-off will necessarily be more complex than the example given, but this system provides additional "richness" to flat checklists or forms. Monroe suggests that "while platforms and checklists may help provide critical clinical information, there is a risk that context can be lost in content" (2006, p. 3). The whole picture must be handed over and some innovative facilities have embedded important elements of complete transfers into the SBAR format. If the transition(hand-off model is comprehensive, another positive impact of SBAR is accurate medication reconciliation.

Gradually, I have learned that "less is more." I still cannot bring myself to completely disregard the niceties of interpersonal relationships with colleagues; but I do make a concerted effort to state the facts and make recommendations in a more streamlined fashion. So, unlike many of my Editorials, I will stop here and keep it BRIEF!!

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