Introduction
In the high-stakes environment of an NHS hospital, clear communication is not just a soft skill—it’s a critical patient safety procedure. Clinical handovers are a well-known high-risk period, where miscommunication can lead to diagnostic delays, medication errors, and significant patient harm. This is why a structured, reliable tool is not just recommended, but essential.
The SBAR handover tool is the NHS gold standard for clinical communication. Mastering it is a non-negotiable skill for passing the UKMLA CPSA and surviving your first day as an FY1 doctor. It is the framework that underpins almost every professional conversation you will have, especially when making an effective NHS referral. This 5-step guide will break down the SBAR tool, transforming it from a simple acronym into a powerful method for safe and effective practice.
Key Takeaways
SBAR is the Gold Standard: It is the approved, structured method for all clinical handovers in the NHS to reduce errors.
It’s a Core CPSA Skill: The CPSA will test your ability to use SBAR to communicate, refer, and escalate care in a clear, safe, and professional manner.
“A” is for Assessment: The “Assessment” step is where you stop being a reporter and start acting as a clinician, synthesising the data to state what you think is wrong.
It’s Not Just for Referrals: SBAR is a versatile tool for all communication, including ward-round updates, handing over to the night team, and speaking to senior nurses.
Why This SBAR Handover Tool Guide is a Non-Negotiable UKMLA Skill
This sbar handover tool guide is not just an academic exercise; it’s a core competency for UKMLA and FY1 success.
The National Standard for Patient Safety
Structured handovers are a national patient safety priority. The National Institute for Health and Care Excellence (NICE) explicitly states that a “structured tool (for example, SBAR) is used” to ensure handovers are safe. This is the E-E-A-T foundation of your practice.
“A structured tool (for example, SBAR) is used to standardise the clinical handover of patients between healthcare practitioners.”
Using SBAR demonstrates your commitment to professionalism and patient safety, proving to examiners that you are ready for safe practice.
How SBAR is Tested in the UKMLA (AKT and CPSA)
AKT: You may get questions that require you to identify the most important piece of information to include in a handover (e.g., the “Assessment” or “Recommendation”).
CPSA: This is where SBAR is directly tested. You will be in a simulated station—either on the phone or in person—where you must refer a patient, hand over to a senior, or escalate a concern. Using the SBAR framework clearly and confidently is the primary mark-scoring action.
Beyond Referrals: Using SBAR for All Clinical Handovers
A common novice mistake is thinking SBAR is only for urgent referrals. This is incorrect. You should use the SBAR mental model for:
Ward Round Updates: Presenting a patient to your consultant.
Night Handover: Giving the night team a “jobs list” for your patients.
Nurse Communication: Updating a nurse about a patient’s new plan or a change in their condition.
The 5-Step Guide to a Perfect SBAR Handover
The 5-step process includes a critical preparation step before you even start the acronym.
Step 1: Prepare (Gather Your Information Before You Call)
Never call a senior or another specialty unprepared. This is unprofessional and wastes time. Before you dial, have this information in front of you:
Patient’s full details (Name, DOB, NHS Number).
The patient’s notes, drug chart, and observation chart.
The most recent blood results and investigation findings.
A clear idea of why you are calling and what you want.
Step 2: Master the Situation (A 10-second summary)
This is the “headline.” It states who you are, where you are, and the exact problem.
Includes: Your name, grade, and location. The patient’s name and location. The single, most important reason for your call.
Example: “Hi, this is [Your Name], the FY1 on Ward 10. I’m calling about Mr. John Smith in Bed 5. I’m concerned he has a new, suspected PE and I need your urgent review.”
Step 3: Master the Background (Relevant history only)
Give only the relevant clinical context. The person you are calling does not need the patient’s entire life story.
Includes: Date of admission and reason for admission. Relevant past medical history (e.g., “He is 3 days post-op from a hip replacement”).
Example: “He was admitted 3 days ago for an elective right total hip replacement. His past medical history is only relevant for hypertension.”
Step 4: Master the Assessment (This is where you show your clinical judgment)
This is the most important step for a UKMLA candidate. You must synthesise the data and state what you think is going on.
Includes: Your A-B-C-D-E findings. Key vital signs, NEWS2 score, and relevant investigation results. Your clinical impression.
Example: “My assessment is that he is acutely unwell. His obs are: HR 120, RR 24, Sats 90% on 2L, and BP 100/60. His NEWS2 score is 7. He has a clear chest and his ECG just shows a sinus tachycardia. Given he is post-op and now acutely tachycardic and hypoxic, my primary concern is a pulmonary embolism.”
Step 5: Master the Recommendation (Your clear and direct “ask”)
End the conversation with a clear, assertive recommendation or “ask.” Do not be vague (e.g., “I was just wondering what you thought…”).
Includes: What you want from the person you are calling. The timeframe you expect.
Example: “My recommendation is that he needs an urgent senior review at the bedside. Could you please come and assess him with a view to starting treatment-dose anticoagulation and ordering a CTPA?”
SBAR in Detail: What to Include in Each Section
The Royal College of Emergency Medicine (RCEM) highlights that structured tools are essential for safe handovers. Here is how to build each component perfectly.
Table 1: The 4 Components of SBAR Explained
| Component | Purpose | Key Question to Answer |
|---|---|---|
| S – Situation | The “Headline” | “Why am I calling *right now*?” |
| B – Background | The “Context” | “What is the *relevant* history that led to this?” |
| A – Assessment | The “Problem” | “What do I *think* is going on?” |
| R – Recommendation | The “Plan” | “What do I *want* you to do?” |
The SBAR Script: What to Say in a CPSA Station
This is a core CPSA skill, often tested via a telephone station. Your examiner wants to see a calm, structured, and safe handover.
What to Say: The Perfect SBAR Handover (CPSA Script)
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(You are calling your senior registrar about a deteriorating patient)
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“Hi, is this the medical registrar? My name is [Your Name], I’m the FY1 on the Acute Medical Unit. Is now a good time to talk?”
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(S) Situation: “I’m calling about a patient, Mrs. Jane Roe in AMU Bed 3, who I’m very concerned about. She has become acutely short of breath and confused in the last 20 minutes.”
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(B) Background: “She’s a 78-year-old lady who was admitted 2 days ago with a community-acquired pneumonia. She was improving on IV Co-amoxiclav. Her past history includes COPD and Type 2 Diabetes.”
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(A) Assessment: “I’ve just done an A-to-E assessment. She’s struggling to speak. Her airway is clear. Her RR is 30, and her sats are 88% on her usual 2L of oxygen. She has widespread wheeze and crackles on her right side. She is tachycardic at 115, BP is 95/50. She is new-onset confused, GCS is 14/15, and her blood glucose is normal. My assessment is that she is in respiratory distress, likely due to worsening pneumonia and a severe COPD exacerbation. She has a NEWS2 score of 9 and looks septic.”
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(R) Recommendation: “My recommendation is that I need you to come and review her immediately. While I wait for you, I will increase her oxygen, get an urgent ABG and blood cultures, and give her a back-to-back nebuliser. Do you agree with that plan?”
Tips for a Confident Verbal Handover
Write it down first: Before you call, quickly jot down your S-B-A-R points in your notebook.
State your “ask” clearly: Don’t be afraid to be direct. “I need you to come and see the patient” is a safe and professional request.
Close the loop: At the end, confirm the plan. “Great, so I’ll do X and Y, and you will be here in 10 minutes. Thank you.”
For more tips, see our full guide on how to manage a phone consultation.
Table 2: Common SBAR Pitfalls and How to Fix Them
| Common Pitfall | Why It’s a Problem | How to Fix It |
|---|---|---|
| ✗ “Waffling” Background | Giving too much irrelevant history (e.g., “he had a bunionectomy in 1992”). This buries the key info. | ✓ Be ruthless. Only include information relevant to the *current* problem. |
| ✗ Skipping the “A” | Just listing observations (“His HR is 110, his BP is…”) without saying what you think is wrong. | ✓ Synthesise. “My assessment is that he is in hypovolaemic shock” is much better. |
| ✗ The Vague “R” | Ending with “So… yeah” or “I was just wondering…”. This is weak and unclear. | ✓ Be specific. “My recommendation is that you come and review the patient now.” |
Putting It Into Practice: 2 UKMLA-Style Clinical Scenarios
Scenario 1: The Urgent Referral (Suspected PE)
Vignette: You are the FY1 on a surgical ward. You are asked to review a 68-year-old man who is 4 days post-op for a bowel resection. He is suddenly short of breath and pleuritic chest pain.
SBAR Application:
S: “I’m calling from the surgical ward about Mr. Davies. I’m concerned he has an acute PE.”
B: “He is 4 days post-op from a major abdominal surgery for bowel cancer.”
A: “His sats have dropped to 91% on air, he is tachycardic at 110, and his RR is 22. His chest is clear. My assessment is that a PE is the most likely diagnosis given his recent surgery and acute symptoms.”
R: “I am starting him on high-flow oxygen. I recommend we start treatment-dose LMWH immediately and I need you to review him and approve an urgent CTPA.”
Scenario 2: The Night Team Handover
Vignette: It’s 8 PM and you are handing over your patients to the FY1 on the night team. You have one patient you are worried about.
SBAR Application:
S: “This is about Mr. Patel in Bed 12. He is the patient I am most concerned about tonight.”
B: “He’s a 65-year-old man admitted with heart failure. He is on a furosemide infusion.”
A: “My assessment is that he is fluid overloaded, but his U&Es are worsening. His creatinine has gone from 120 to 160, and his potassium is 5.3. He is at risk of both pulmonary oedema and severe hyperkalaemia.”
R: “My recommendation is that you must re-check his U&Es at 10 PM. If his potassium is >5.5 or his creatinine is >180, please call the renal registrar for advice. Please do not let this blood test be missed.”
Your Turn: A Self-Assessment Exercise
Scenario: You are the FY1 on a surgical ward. You are called to review a 70-year-old woman, 2 days post-op from a hip replacement. The nurse tells you her urine output has been <20ml/hour for the last 3 hours. You review her and find her BP is 90/50, HR 115, and she looks pale.
Your Task: Write out the 4 SBAR components for your urgent phone call to the surgical registrar.
Model Answer:
S: “Hi, this is [Your Name], the FY1 on the orthopaedic ward. I’m calling about Mrs. Green in Bed 7. I’m concerned she is in hypovolaemic shock.”
B: “She is 2 days post-op from a hip replacement. Her drain output was 400ml in the last 2 hours.”
A: “My assessment is that she is actively bleeding. She is hypotensive at 90/50, tachycardic at 115, and has had a very low urine output. She is likely bleeding into her wound site.”
R: “I have just sent an urgent FBC, crossmatch, and coagulation screen. I am starting an IV fluid bolus now. I recommend you come and review her immediately as she may need to go back to theatre.”
Frequently Asked Questions (FAQ) about the sbar handover tool guide
This is a classic CPSA scenario. Your priority is the patient. Do not get emotional. Remain calm and professional, and stick to the facts of your SBAR. If they reject your “Recommendation,” be respectfully assertive: “I understand, but I remain very concerned for the patient’s safety because of [re-state your ‘Assessment’]. I would like you to come and review them.” If they still refuse, you must escalate to your own senior (e.g., your registrar or consultant).
SBAR is the structure for both, but the level of detail changes. A phone call is for urgent issues and focuses on your “Assessment” and “Recommendation” (the “A” and “R”) to get immediate action. A written referral (like on an electronic system) requires a more detailed “Background” section, as it serves as a formal medical-legal document. You are still answering S-B-A-R, but the “B” will be more built-out in the written version.
Absolutely. It’s the perfect tool. For example: (S) “I’m calling about Mr. Smith in Bed 4. I’ve just reviewed his TTOs.” (B) “He’s going home today.” (A) “My assessment is that the medication changes are complex, and he seems unsure about them.” (R) “My recommendation is that he must have pharmacist counselling before he leaves the ward. Can we please ensure this is arranged before his transport arrives?”
Skipping the “A” (Assessment). A novice doctor will just list the facts: (S) “This is Mr. Smith.” (B) “He came in with X.” (A) “His HR is 110, BP 90/50, RR 22.” (R) “What should I do?” This is just reporting data. It forces the senior doctor to make the assessment for you. A good FY1 will say: (A) “My assessment is that he is in hypovolaemic shock, likely from a bleed.” This shows your clinical judgment and is what examiners want to see.
For an urgent phone referral, you should be able to deliver your SBAR in 60-90 seconds. This is why Step 1 (Prepare) is so important. Having your thoughts organised beforehand allows you to be clear, concise, and professional. It should be a “long elevator pitch” for patient safety.
Some local trusts use variations like “I-SBAR” (Introduction) or “SBAR-D” (Diagnosis). The “I” is simply Step 1: “Hi, this is [Your Name], the FY1 on [Ward].” We include this as part of the “S” (Situation) component, as it’s the natural way to start a phone call. Don’t get lost in the acronyms; just ensure you’ve introduced yourself clearly.
This is a sign you need to escalate to your senior first. It is perfectly acceptable to call your own registrar and say: (S) “I’m calling about Mr. Smith.” (B) “He has X, Y, Z.” (A) “I’ve reviewed him, and I’m not sure what’s going on, but his NEWS2 score is 8 and I’m worried.” (R) “Can you please come and review him with me, or advise me on who to refer to?” This is a very safe and professional action.
No. SBAR is designed to be a “common language” for all healthcare professionals. Nurses, pharmacists, physiotherapists, and doctors all use it. This is what makes it so effective. A nurse can call you using SBAR: (S) “I’m calling about Mr. Smith in Bed 2, I’m worried he’s septic.” (B) “He’s 2 days post-op.” (A) “His temp is 38.5, and his BP has dropped to 90/60.” (R) “I need you to come and review him immediately.”
You use SBAR principles, but in a modified “list” format. For each patient, you quickly summarise:
S: “Mr. Jones, Bed 5. Stable.”
B/A: “Admitted for asthma. No issues, for discharge tomorrow.”
R: “No specific jobs for you.”
…then for the sick patient:
S: “Mrs. Smith, Bed 8. Unstable.”
B: “Admitted with DKA, on an insulin sliding scale.”
A: “She’s at high risk of her potassium dropping.”
R: “You must re-check her VBG and potassium at 2 AM.”
The best place to start is the official NHS England SBAR Implementation and Training Guide. It provides the full context and demonstrates why this tool is so central to the NHS patient safety strategy.
Conclusion
The SBAR handover tool is one of the most powerful and versatile skills you will learn. It is far more than just a passing fad or an exam hoop to jump through; it is a critical safety procedure, backed by national guidance from NICE and the NHS, that saves lives by reducing miscommunication.
By mastering this 5-step framework, you are demonstrating to your colleagues and your CPSA examiners that you are a safe, competent, and professional clinician. This tool will be your foundation for clear communication on your first on-call shift as an FY1 and every day after.
Your Next Steps
Practice it: Don’t wait for an emergency. Use the SBAR structure for your next routine ward round update.
Role-play it: Ask a colleague to role-play the “dismissive registrar” scenario with you. Practice staying calm and assertive.
Observe it: Listen to your senior registrar the next time they make an urgent referral. Notice how they structure their call—it will almost certainly follow the SBAR framework.
