Streamlining Communication with Attorney Clients with SBAR

Do you know how to have great communication with attorney clients? Consider this situation: Your client asks you to review a case for merit and to prepare an analysis report. Legal nurse consultants come from the medical world where targeted communication is prized. You see concerning changes in your patient’s condition. You pick up the phone to call the physician. What you say and how you organize the information is crucial.

SBAR Explained

Consider taking a model that works in the clinical world and apply it to communication with attorney clients in an analysis report: Use SBAR – situation, background, assessment and recommendations. Pronounced S-Bar, this term refers to a methodology that was designed to ensure effective, accurate, mistake-free communication between medical staff and each other as well as with physicians and other healthcare professionals.

SBAR was originally established as a standard operating procedure of communication between the captain and the crew on US Naval submarines. Kaiser Permanente adopted the technology several years ago for the medical field to slash the rising statistics of human error. It was instrumental in pioneering SBAR as a model to assist both the nurses and doctors to systematize their thoughts so they could convey the most critical information in under one minute.

Each recorded medical update starts out with describing the situation surrounding the need for care, gives the background pertinent to that care, assesses what needs to be done and provides a recommendation as to a proper plan of action.

SBAR Example
Let’s take an example. Say that Mr. Sanchez receives a medication prescribed by the physician on rounds. Within ten minutes of its administration, he develops a rash on his chest and abdomen and starts exhibiting diaphoresis.

The nurse calls the physician to report the incident, giving his or her name, the patient’s name, and a brief description of the situation.

Situation
“Dr Smith, this is Delores Schwartz on 4 South at Mercy Hospital. This is the situation. Mr. Jorge Sanchez in 420B at 10:05 this morning received the dose of 0.5 mg Xanax you prescribed for anxiety on your morning rounds. At 10:15 this morning, he buzzed the floor nurse complaining of sweating and itching on his chest.”

Background
Then a brief background is given. This is two-fold. It clarifies the patient’s history, so there is certainty the right patient is being discussed, and it reminds all personnel involved of the patient’s history and condition leading up to the incident.

“Here is his background. As you know, Mr. Sanchez was admitted over the weekend for shortness of breath and chest pains. His EKG was unremarkable, but he had just lost his job, has a wife on disability, and has a son in Iraq. He has a reported history of medication sensitivity and is allergic to Codeine, penicillin and peanuts. He reports not sleeping well for the past month, and having bouts of severe indigestion. His vital signs are 185/96 with a respiration of 28 and a pulse of 82. Medication was verified as correct in quantity and dosage prior to administration via bracelet ID.”

Assessment
The assessment of the situation is given next. The nurse gives an analysis of the situation based on her observation and expertise.

“My assessment is that the patient seems anxious, having had bad reactions to medications in the past. His wife is here with him. He does have small reddish blotches on his abdomen and they are spreading upwards into his chest. He is scratching vigorously. He is diaphoretic and his palms are clammy. His speech is clear and his tongue does not appear to be swelling. He can swallow without trouble and breathing is shallow but not labored.”

Recommendation
Finally, the nurse gives her recommendation of what she believes would be the best course of action. The nurse is not telling the doctor what to do, but clarifying options. This is often offered in a form of a question. Additionally, the nurse offers the listener a chance to ask questions.

“I would recommend he be prescribed Benadryl and a cortisone cream, or do you want us to run lab work, or do you wish to return and re-evaluate him? Do you have any questions?”

SBAR applied to an Analysis Report for Streamlining Communication with Attorney Clients

It occurs to me that SBAR is a perfect way to structure an analysis report. (Your report may be oral or written.) Here are the elements and some suggested dialogue:

Situation: “You’ve asked me to screen this potential medical malpractice case for merit. This is my conclusion: I believe this case has merit and should be pursued.”

Background: “The patient was a 45-year-old man who went to the emergency department complaining of chest pain. He reported that it felt like an elephant was sitting on his chest.” (Add more details here)

Assessment: Include your assessment of the merits of the case. “The standard of care for the diagnosis of chest pain in the emergency department is…” Also anticipate the potential defenses for the claim and address them.

Recommendations: Offer guidance to the attorney. “I recommend that this case be reviewed by a board certified emergency physician.”

Make sense?

Pat Iyer is president of the Pat Iyer Group and has written thousands of LNC reports.