SBAR – quick report format – situation, background, assessment, recommendation



In a nutshell :

SBAR – quick / rapid report handoff format adopted by hospitals.

why the submarine pic ?  SBAR format was initially designed by submarine personnel.

The long winded version :

(in a submarine : deep, deep underwater with limited oxygen supply and tons of crushing pressure all around, there is not time for lengthy speeches – its more like “you have 2 seconds to tell me what’s wrong and how you would fix it”.


I was told a long time ago, by my supervisor back then, “don’t come to me with just a problem … have a suggested solution as well”.  I have always liked that management style and give her credit for introducing me to that notion.


The third point, always know the history of anything and everything (in this case : SBAR came from the military).

We should treat a patient in crisis just like we were having a crisis in a submarine :

tell me the problem.

give me relevant background quickly.

tell me why you think the problem happened.

tell me how you would fix it.

Tricks of the trade – what your patient’s urine collection bag is telling you.



yellow =  normal


darker yellow = concentrated urine (patient may be dehydrated)


red (non-translucent) = traumatic catheter insertion / traumatized genitourinary (GU) system.


red (translucent) = hemoglobinurea (free hemoglobin in urine) >> may cause acute renal failure > keep patient mildly alkalemic to avoid free hemoglobin-distal convoluted tubule complexes from forming.


green / light blue – patient may be receiving MethleneBlue intravenously as “nitric oxide scavenger” therapy (MORE TO FOLLOW).  or after abdominal surgery (if JP drains drain from the abdomen, there is a vascular leak in the abdomen (MORE TO FOLLOW).


near clear = likely a “forced” diuresis (ex. Lasix)


red (from dark red > to light red > to clear) – likely, ongoing bladder irrigation as a washout of bladder.


2 bottles hanging  are infusing into the bladder – to be followed by release of bladder irrigant into urine collection bag.

The ICU patient – evaluating the patient in 2 minutes



Why would you want to evaluate a patient in 2 minutes?

>> To be able to answer anyone who asks : “How’s my patient doing?”

> answer quick and BE READY to defend your stance!

>> Why you think the patient is faring well vs. why you think the patient is decompensating.

>> if they like your answer over the course of 1 to 2 patients (and you were correct),

they will trust you for the rest of your life with anything respiratory related and

patient related as well.

How do you evaluate the patient in 2 minutes?

>> 7 zones to focus on :  2 min = 120 seconds

>> patient.  10 sec

>> patient monitor.  10 sec

>> IV pumps.  30 sec

>> ventilator.  10 sec

>> chest tube.  10 sec

>> urine collection bag.  10 sec

>> any other unusual device in room.  10 sec

>> conclusion and defense thesis.  30 sec

PATIENT :  10 seconds

cyanosis / pale / normal

MONITOR :  10 seconds

HR :  hi  /  lo  / normal
BP :  hi  /  lo  / normal

PA :  hi  /  lo  / normal

CVP :  hi  /  lo  / normal

SpO2 :  hi  /  lo  / normal

IV PUMPS :   30 seconds

Vasoactives :  constrictors  vs.  dilators

Cardiotonics :  inotropes  vs.  chronotropes

Sedation :

Analgesics :

Paralytics :

Epi  /  Levo  /  Neo  /  Vaso  /  Milrinone

Diprivan  /  Ativan  /  Versed  /  Fentanyl

VENTILATOR :   10 seconds

Type & Mode of Ventilation :   VCV  vs.  PCV  ;  AC  vs.  SIMV  vs. PSV

PEEP :    hi  /  lo  / normal

FiO2 :    hi  /  lo  / normal

P/F ratio :  hi  /  lo  / normal

Lung compliance :   hi  /  lo  / normal

CHEST TUBE :   10 seconds

Qualitative analysis :

Quantitative analysis :  hi  /  lo  / normal


Qualitative analysis :  clear  /  yellow  /  pink  /  red  / green  /  blue

Quantitaive analysis :    hi  /  lo  / normal

UNUSUAL DEVICES  :  10 seconds

EEG  /  Hypothermia Induction Device  / IAB / VAD / ECMO, CVVH, hemodialysis, wound VAC, compression stockings, external pacing device, cardio-defibrillator, video monitor, patient escape alert device.

CONCLUSION :  immediate

Rationale :  30 seconds

(MORE TO FOLLOW next week)