Journal of Health and Nutrition Research Vol.
No.
2, 2025, pg.
464-473, https://doi.
org/10.
56303/jhnresearch.
Journal homepage: https://journalmpci.
com/index.
php/jhnr/index e-ISSN: 2829-9760 Analysis of Handoff Communication Using SBAR (Situation.
Background.
Assessment.
Recommendatio.
in Emergency Department and Intensive Care Unit: A Scoping Review Nur Azmi1.
Ayu Prawesti Priambodo2*.
Aan Nuraeni2 1 Master Study Program.
Faculty of Nursing.
Universitas Padjadjaran.
Sumedang.
Indonesia 2 Department of Critical and Emergency Nursing.
Faculty of Nursing.
Universitas Padjadjaran.
Sumedang.
Indonesia Corresponding Author Email: ayu.
prawesti@unpad.
Copyright: A2025 The author.
This article is published by Media Publikasi Cendekia Indonesia.
SCOPING REVIEW
ABSTRACT
Submitted: 26 April 2025 Communication between health workers is crucial in providing nursing care and improving patient safety.
Communication problems can cause incidents that lead to disability or death.
This study aimed to identify the implementation of handoff communication using sbar in the emergency department and intensive care unit.
This review used a scoping review design that uses the Arksey and O'Malley framework.
Article searches through two databases, namely Sciencedirect and Pubmed, and the search engine.
Google Scholar.
The keywords used were "Health workers or Healthcare professionals AND SBAR implementation or SBAR or Handoff Communication AND Emergency rooms or Emergency departments AND Intensive Care Unit".
There were nine articles that fulfilled the inclusion criteria and were analyzed in this study.
The results of the review showed that the description of the implementation of handoff or SBAR communication, studies showed variations in the effectiveness of its implementation in various countries and health settings.
There are several factors that influence the implementation of SBAR and the implementation of handoff, namely work experience, attitudes, knowledge, and formal Implementation of handoff communication and SBAR still shows substansial challenges, both in terms of effectiveness and quality.
Although SBAR has been widely recognized as an effective tool to improve communication, its implementation is uneven across countries and health SBAR implementation is often disrupted by factors such as external interference, lack of training, or incomplete information conveyed during the handover process, which ultimately affects patient safety.
Accepted: 15 May 2025 Keywords:
CT-scan.
Osteoporosis.
Osteopenia.
Bone Quality.
Attribute.
Imaging.
This work is licensed under a Creative Commons Attribution-NonCommercialShareAlike 4.
0 International License Access this article online Key Messages:
Quick Response Code SBAR in ED and ICU is effective but not optimally implemented.
Several factors that influence the implementation of SBAR and the implementation of handoff, namely work experience, attitudes, knowledge, and formal training Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
GRAPHICAL ABSTRACT
INTRODUCTION
Handoff communication is a crucial aspect in the medical world, especially in the Emergency Department (ER) and Intensive Care Unit (ICU).
In this context, handoff serves as a critical point where information about a patient is transferred from one healthcare provider to another.
An effective process can prevent medical errors, reduce treatment time, and improve patient safety .
However, misunderstanding and ambiguity in communication can result in serious consequences for the patient.
In the ED and ICU, the often urgent situations and high time pressure present challenges in ensuring effective communication .
Previous studies have reported that factors such as lack of time, stress, and chaotic environments can contribute to errors in handoff communication .
In this context, it is important to create a standardized communication system to improve the accuracy and efficiency of the information conveyed.
One important aspect of handoff communication is the use of tools and technology that can support the process.
Tools such as checklists and electronic systems for sharing information can help reduce errors and ensure that all important aspects are communicated properly .
In addition, training and education for healthcare workers regarding best practices in handoff can also improve the quality of communication and patient care outcomes .
The SBAR method is a standard communication system used to communicate information about patient management in a structured manner .
The steps in SBAR include: Situation.
Background.
Assessment, and Recommendation.
This method is designed to improve the quality of communication between health workers, both in direct verbal communication and over the phone.
The use of SBAR has been applied in a variety of situations, including communication between nurses and doctors, consultations between doctors, and changing of shifts .
Implementation of structured communication methods, such as SBAR, can improve the quality of handoff in the ED and ICU .
This method allows healthcare providers to convey information in a consistent and systematic manner, reducing the likelihood of misinformation that could harm patients.
However, despite the variety of methods and tools available, substansial challenges remain related to organizational culture and individual attitudes in the handoff process.
Research shows that effective communication depends not only on the tools used, but also on the interpersonal relationships between members of the medical team .
Therefore, building a culture of open and collaborative communication among health workers is very important.
However, even though SBAR has been proven effective, there are still challenges in its One of the main challenges is the lack of knowledge and understanding of this method https://doi.
org/10.
56303/jhnresearch.
Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
among health workers .
In addition, differences in training and experience among healthcare workers can lead to uncertainty and confusion during handoff.
Another challenge faced in handoff communication is the difference in training and experience among health workers involved in the handover process.
Research has shown that differences in knowledge and experience can lead to uncertainty and confusion during handoff .
Therefore, it is important to ensure that all team members have the same understanding of the procedures and information that needs to be conveyed.
Thus, while SBAR has proven effective in many settings, its implementation faces significant barriers due to differences in training, understanding, and institutional support .
Ae.
Overcoming these challenges requires a comprehensive approach that not only focuses on the tools themselves but also addresses the cultural and interpersonal dynamics that shape communication within healthcare teams.
This study aims to conduct a scoping review of handoff communication in the ED and ICU to identify the practical challenges, best practices, and strategies for improving handoff communication in these settings.
The findings from this review will inform the development of targeted strategies for improving SBAR implementation and fostering a culture of effective communication in critical care environments.
METHODS
This scoping review uses the Arksey and OAoMalley framework, which defines a scoping review as a literature synthesis method used to present and identify the scope of research on a particular topic .
The scoping review framework includes five main stages, namely formulating review questions, identifying relevant research, selecting studies, mapping data, and summarizing and reporting findings .
Inclusion and Exclusion Criteria The process of selecting articles for this review was carried out by three authors based on the PRISMA Extension for Scoping Review (PRISMA-ScR) .
ee Figure.
Research questions and eligibility criteria for research articles using the PCC (Population.
Concept, and Contex.
P (Populatio.
: Nurse or Health Care Worker C (Concep.
: Handoff Communication C (Contex.
: Emergency Installation and Intensive Care Unit In this review, full-text articles that were not accessible, publications not in English, and secondary studies were excluded.
Inclusion criteria for this review were full-text articles that were accessible and published in English, articles with quantitative and qualitative designs that discussed handoff communication in the emergency department and intensive care uni.
In this review, the year of publication of the article was not limited so as to maximize the literature search.
The three authors independently (NA.
APP, and AN) screened the articles for inclusion, and a consensus process was used to resolve any disagreements.
In cases where there were discrepancies in the selection of articles, the authors discussed the differences and reached a mutual agreement.
This approach ensured that the selection process was both thorough and objective.
Search Strategy Articles searched for October to November 2024.
Article identification was carried out systematically using two main databases: Sciencedirect.
Pubmed, and the search engine Google Scholar.
The keywords used were AuHealth workers or Healthcare professionals AND SBAR implementation or SBAR or Handoff Communication AND Emergency rooms or Emergency departments AND Intensive Care UnitAy.
The author uses the Boolean operators AuANDAy and AuORAy to narrow or expand search results.
Data Extraction and Analysis In this review, data extraction from the studies analyzed using a table that can describe in detail all the results related to the topic discussed.
The information presented in the extraction table is related to the characteristics of the study: author and year, country, design, sample, and research results.
Then, data analysis was carried out thematically with an exploratory descriptive approach.
The data analysis process begins with the identification and presentation of data obtained in the form of tables based on the reviewed After obtaining the data, all authors analyzed and explained each finding based on the extraction Finally, the authors rechecked the articles analyzed to ensure and minimize errors during the extraction stage.
https://doi.
org/10.
56303/jhnresearch.
Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
RESULTS
Literature Search Results Based on the search results in Figure 1, it shows that the total number of articles found was 682, consisting of Sciencedirect .
PubMed .
, and Google Scholar .
After filtering based on title and abstract, 593 articles were selected, but 89 articles were removed due to duplication, and 577 articles were removed because they did not meet the title and abstract criteria.
Furthermore, articles were filtered based on inclusion criteria related to population, intervention, and language, with a total of 16 articles eligible.
After full-text assessment, only 9 articles were declared eligible for analysis in this review.
The articles removed at this stage were 7, with 5 articles removed because the population was not appropriate .
ard room settin.
and 2 articles did not discuss the implementation of SBAR or handover communication in the emergency room and ICU.
Figure 1.
Article Search Flow Diagram Characteristics of Studies Table 1 shows a total of nine studies from various countries.
These studies include Singapore.
Switzerland.
Iran.
Kenya.
Indonesia .
ith three studie.
Hong Kong, and the United States.
These studies were conducted in various health contexts, such as ICU.
ED, medical-surgical wards, and cardiovascular Samples varied from 17 to 206 participants, most of whom were nurses and other health The studies included various designs, such as cross-sectional, observational, and qualitative studies, with most settings located in intensive care units or emergency departments.
https://doi.
org/10.
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Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
Table 1.
Data Extraction Sample and Results Setting Sampel:
The results showed that there were 1.
Handover (A1.
interruptions per handover.
In 45 .
%) handovers, there were no couples .
There were more distractions in the 50 nurses to morning shift.
The more distractions, the .
longer the handoff time.
and 40 3.
The information that was least often included was AuDo not ResucitationAy (DNR).
Nurses spent significantly longer during handovers than doctors.
Ref Location Design Singapore Crosectional .
Swiss Observational .
Iran Qualitative Sample:
Setting: ICU Africa Sample:
Indonesia Qualitative Setting: ICU Sample:
Setting: ED Hongkong Quantitative Setting: ICU Sample:
Setting: ICU Sample:
Setting:
ICU,
There were 290 phone calls made by 99 The median SBAR quality score was 41% .
nterquartile range [IQR] 33Ae.
Factors independently associated with higher SBAR quality were age, primary language other than French, lack of ICU expertise, and SBAR training in undergraduate nursing education.
The results of this study indicate that many factors influence error communication, some facilitating it and some prohibiting it.
Organizational factors such as error consequences of error communication for nurses and patients, as well as individual and professional characteristics, including interprofessional relationships, influence this process.
Implementation of SBAR training can improve group communication openness scores, timeliness of communication, and patient safety and frequency of reported events.
The most common situation communication was the sufficient category, with 18 respondents .
9%).
for background communication, the most common was the good category, with 16 respondents .
1%).
for assessment communication, the most common was also the good category, with 21 .
8%).
recommendation communication, the most common was the good category, with 20 respondents .
8%).
High perception of ISBAR communication protocol, other factors significantly correlated with improved handover Nurse handover quality depends on nurses' level of understanding of the https://doi.
org/10.
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Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
Ref Location Indonesia United Design Crosectional Crosectional Sample and Setting Sample:
Results Setting:
Cardiovascular unit (CVICU) Sample:
Setting: ED Indonesia Crosectional Sampel:
Nurses Setting:
Medical nursing wards, and ED patient's care plan.
ISBAR communication protocol is considered to help nurses improve their communication skills The results of the study indicate that there is a significant relationship between motivation, and the application of the SBAR method.
The dominant factor in the application of the SBAR method is the attitude variable.
Of the 75 handoffs observed, only 13% were documented in the electronic medical record.
The mean handoff score based on the IMIST-AMBO protocol was 3.
29 out of 9.
The AuPatient IdentificationAy category was consistently present in the handoff report, while other important information, such as medical history and allergies, was rarely Work experience is significantly related to effective communication .
value = 0.
while no correlation was found between gender or education level with effective communication .
value > 0.
Effective communication using SISBAR is related to work experience.
Factor Associated with Handoff Communication in ICU and ED Factors that influence the quality of communication during handover include individual characteristics, training, experience, and organizational conditions.
Research shows that factors such as age, experience, and training related to the SBAR protocol play an important role in improving communication quality, where ICU experience and educational background influenced communication In Iran, organizational culture that supports error communication and interpersonal relationships also have a significant impact .
In Indonesia, nurses' work experience is directly related to the effectiveness of communication using the SISBAR protocol .
Overall, training, experience, and organizational culture are the main factors that determine the effectiveness of handover.
Effectiveness of SBAR in Different Settings The effectiveness of the SBAR protocol varies depending on the setting in which it is applied.
Indonesia, studies in emergency departments and medical wards show that the effectiveness of SBAR communication is influenced by the nurses' work experience.
In Switzerland.
SBAR improves communication quality among trained nurses, but the quality is lower among those with less training.
Africa.
SBAR training has been shown to enhance communication and patient safety.
In contrast, in the United States, only a small portion of handovers are documented in electronic medical records, highlighting a gap in documentation.
Meanwhile, in Hong Kong, the ISBAR protocol improved nurses' communication skills and overall handover quality.
Overall, the effectiveness of SBAR depends on training, experience, and organizational support.
DISCUSSION
The use of SBAR (Situation.
Background.
Assessment.
Recommendatio.
in handoff communication in emergency departments and intensive care units is increasingly recognized as an https://doi.
org/10.
56303/jhnresearch.
Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
effective method in improving the quality of communication between healthcare professionals.
Research shows that the application of SBAR notably decreases communication errors, which are often the main cause of medical incidents.
The clear structure of SBAR allows for the delivery of crucial information in a systematic way, thereby improving understanding among members of the medical team .
The implementation of handoff using the SBAR method in the ED shows varying results in various countries .
ee Table .
In several studies, it was found that although SBAR is widely recognized as an effective method for improving communication, its implementation in the ED is often suboptimal.
For example, a study in the United States found that only 13% of handoff processes were properly documented in the electronic medical record, indicating that there are still problems in the consistency of SBAR implementation .
In Indonesia, a study in the ER showed better results, where 47.
1% of background communication and 61.
8% of assessment communication were categorized as good, indicating that most health workers in the ER were able to implement SBAR effectively .
However, there are also aspects that still need to be improved, such as in terms of situational communication which is still considered sufficient 9% of respondents .
While SBAR has been recognized for improving communication and reducing errors in healthcare settings, several limitations and potential biases must be considered in its implementation.
One significant limitation is the variability in training and understanding among healthcare workers, which can affect the consistency and effectiveness of SBAR use .
Ae.
Additionally, the differences in the organizational culture and healthcare systems across various settings may introduce biases in how SBAR is applied and evaluated .
For example, institutions with more hierarchical cultures may have less open communication, which could hinder the effectiveness of structured communication methods like SBAR.
Addressing these biases and ensuring consistency in training is crucial for realizing the full potential of SBAR across diverse healthcare settings.
Implementing SBAR handoffs in the ICU also faces similar challenges to those in the ED, particularly in terms of consistency and quality of implementation.
Several studies have shown that although SBAR is recognized as an effective communication method, its implementation in the ICU is often A study in Switzerland, for example, found that the quality of SBAR implementation among ICU nurses was only 41%, with many nurses reporting difficulty in maintaining a systematic communication structure during interactions with physicians .
External distractions, such as frequent incoming phone calls or a busy ICU environment, are also major factors that hinder smooth handoffs and lead to information errors that are crucial to patient safety.
A study conducted in the ICU by .
provides important insights into the challenges faced during the patient handover process, particularly in relation to disruptions that occur.
The study reported that handover disruptions were more common among nurses and during night shifts.
The most disruptive factors were people .
ncluding staff, family members and patient.
Although the study focused on the ICU, we can extrapolate the findings and consider how similar things might happen in the ED, which is also a busy and often unpredictable environment .
In the ED, patient handover is also a critical process that can be affected by a variety of distractions.
These distractions include interruptions by other staff, phone calls, or the urgent needs of other patients .
Factors such as high workload, urgency of the case, and the need to make quick decisions can increase the potential for disruption .
Additionally.
EDs often experience significant fluctuations in patient volume, which can exacerbate potential disruptions, especially during peak hours or when staffing is reduced, such as on night shifts .
Various factors influence the quality of handoff or SBAR implementation across different studies.
One such factor, work experience, as found in Indonesia, is strongly associated with communication effectiveness .
In addition, formal training on SBAR, as in Kenya, can improve openness of communication and patient safety .
In Switzerland, variables such as a primary language other than French, as well as lack of experience in the ICU, influence the quality of SBAR communication .
Nurses' attitude factors also play a dominant role in the success of SBAR implementation, especially related to their perception of the importance of this protocol.
Overall, the study results indicate that training and https://doi.
org/10.
56303/jhnresearch.
Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
organizational factors, such as communication culture in the workplace, are very important in improving the effectiveness of handoff communication in the ED and ICU.
The effectiveness of SBAR depends largely on how well health workers are trained to use this communication tool.
In countries where health education curricula explicitly integrate SBAR into clinical communication training, as may be the case in Indonesia based on .
The results tend to be more positive.
In contrast, in places where SBAR training is not emphasized, as may be the case in Switzerland based on the findings .
its implementation may not be as effective.
The studies included in this review exhibit considerable diversity in terms of their designs, settings, and sample sizes, reflecting the varied healthcare contexts in which they were conducted.
This heterogeneity is an important factor in understanding the variability in the findings.
For example, the studies span across different countries with distinct healthcare systems, which may influence the implementation and effectiveness of SBAR communication protocols.
Additionally, the range of sample sizesAifrom smaller, more focused studies to larger, cross-sectional surveysAiadds to the complexity of interpreting the results.
Furthermore, the healthcare settings .
ED.
ICU.
Cardiovascular Uni.
in which these studies were conducted also differ in terms of the level of care, the nature of patient conditions, and the team dynamics involved.
These contextual differences may explain why some studies report improved outcomes after SBAR implementation, while others show less significant effects.
Cultural factors and the level of formal training provided to healthcare workers also play a role in shaping the success of SBAR as a communication tool.
This variability highlights the need for further research to explore the factors that contribute to the success or limitations of SBAR in different environments, and to identify best practices that can be applied universally across diverse healthcare settings.
CONCLUSION
The implementation of handoff communication using the SBAR method in the ED and ICU shows varying levels of effectiveness across different countries.
This review indicates that while SBAR is widely regarded as an effective communication tool, its quality is heavily influenced by multiple factors such as individual knowledge and perception, work experience, formal training, and the work environment.
countries like Singapore and Switzerland, the quality of SBAR implementation remains low, whereas in Indonesia and Kenya, improvements were noted, particularly after intensive training programs.
However, key challenges such as environmental interference and inconsistent documentation persist.
To enhance the quality of SBAR implementation in the ED and ICU, it is recommended that health institutions provide continuous formal training for healthcare workers.
Furthermore, future research should focus on strategies to address the factors influencing SBAR implementation, especially external interruptions during the handover process, such as disruptions from other staff or a busy work Research could explore methods to minimize these disruptions, for instance, by creating a more conducive work environment or utilizing technology to facilitate efficient communication under FUNDING This research received no external funding.
ACKNOWLEDGMENTS
Thank you to Padjadjaran University for facilitating researchers by providing an international database, so that researchers can easily search for relevant articles.
CONFLICTS OF INTEREST
The authors declare no conflict of interest.
https://doi.
org/10.
56303/jhnresearch.
Nur Azmi.
Ayu Prawesti Priambodo.
Aan Nuraeni, .
REFERENCES