Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada
Centre for Quality Improvement and Patient Safety, University of Toronto, Toronto, Ontario, Canada.
BMJ Open. 2021 Dec 17;11(12):e055247. doi: 10.1136/bmjopen-2021-055247.
To characterise the extent to which health professionals perform SBAR (situation, background, assessment, recommendation) as intended (ie, with high fidelity) and the extent to which its use improves communication clarity or other quality measures.
Medline, Healthstar, PsycINFO, Embase and CINAHL to October 2020 and handsearching selected journals.
Eligible studies consisted of controlled trials and time series, including simple before-after design, assessing SBAR implementation fidelity or the effects of SBAR on communication clarity or other quality measures (eg, safety climate, patient outcomes).
Two reviewers independently abstracted data according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses on study features, intervention details and study outcomes. We characterised the magnitude of improvement in outcomes as small (<20% relative increase), moderate (20%-40%) or large (>40%).
Twenty-eight studies (3 randomised controlled trials, 6 controlled before-after studies, and 19 uncontrolled before-after studies) met inclusion criteria. Of the nine studies assessing fidelity of SBAR use, four occurred in classroom settings and three of these studies reported large improvements. The five studies assessing fidelity in clinical settings reported small to moderate effects. Among eight studies measuring communication clarity, only three reported large improvements and two of these occurred in classroom settings. Among the 17 studies reporting impacts on quality measures beyond communication, over half reported moderate to large improvements. These improvements tended to involve measures of teamwork and culture. Improvements in patient outcomes occurred only with intensive multifaceted interventions (eg, early warning scores and rapid response systems).
High fidelity uptake of SBAR and improvements in communication clarity occurred predominantly in classroom studies. Studies in clinical settings achieving impacts beyond communication typically involved broader, multifaceted interventions. Future efforts to improve communication using SBAR should first confirm high fidelity uptake in clinical settings rather than assuming this has occurred.
CRD42018111377.
描述卫生专业人员执行 SBAR（情况、背景、评估、建议）的程度（即高保真度），以及使用 SBAR 提高沟通清晰度或其他质量措施的程度。
2020 年 10 月前，通过 Medline、Healthstar、PsycINFO、Embase 和 CINAHL 进行检索，并对选定的期刊进行手工检索。
合格的研究包括对照试验和时间序列，包括简单的前后设计，评估 SBAR 实施的保真度或 SBAR 对沟通清晰度或其他质量措施（如安全氛围、患者结果）的影响。
两名审查员根据系统评价和荟萃分析的首选报告项目，独立提取研究特征、干预细节和研究结果的数据。我们将结果的改善程度描述为小（相对增加<20%）、中（20%-40%）或大（>40%）。
28 项研究（3 项随机对照试验、6 项对照前后研究和 19 项非对照前后研究）符合纳入标准。在评估 SBAR 使用保真度的九项研究中，四项发生在课堂环境中，其中三项研究报告了较大的改善。五项在临床环境中评估保真度的研究报告了较小到中等的效果。在八项测量沟通清晰度的研究中，只有三项报告了较大的改善，其中两项发生在课堂环境中。在报告沟通以外的质量措施影响的 17 项研究中，超过一半报告了中等至较大的改善。这些改进往往涉及团队合作和文化措施。只有通过强化多方面干预（如早期预警评分和快速反应系统），患者结局才会得到改善。
高保真度的 SBAR 采用和沟通清晰度的提高主要发生在课堂研究中。在临床环境中实现沟通以外影响的研究通常涉及更广泛、多方面的干预。未来使用 SBAR 改善沟通的努力应首先确认在临床环境中高保真度的采用，而不是假设已经发生。
PROSPERO 注册号：CRD42018111377。
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