ISBAR

For Clear Communication

Introduction
The health system in Australia relies on efficient and accurate communication between professionals to ensure safe and effective patient care. We introduced a standardised communication technique, ISBAR (Identify, Situation, Background, Assessment, Request), into clinical use across our health service, the largest in Victoria, after having initially established its effectiveness in a study in our simulation environment.

Results
Pilot site 1013 staff attended training at 69 sessions, including several night duty sessions. Staff attending the full training session completed a short pre training survey form, and an evaluation form following the session. Shorter sessions were held for the more experienced and sessional clinicians. Process evaluation of the full training sessions revealed: 72% had never heard of the tool prior to the session 89% found the session worthwhile 88% believed it was relevant to them and their colleagues. In-depth interviews were held 3 months following completion of training, using the following evaluation domains, developed with a program-logic mapping framework; demographics, acceptability of ISBAR, perceived value of ISBAR, and effects of ISBAR. Success case methodology was chosen to collect the appropriate data, 13 participants from the various professions who attended training were invited to participate in the interviews, having been chosen using a stratified random sampling technique. Two of the major themes that emerged from this stage of the project were that ISBAR is most helpful for the junior staff, and works best when both caller and receiver are using the technique. Further evaluation of the whole project will be completed at the end of the training roll out. Lessons learnt 1. The importance of engagement from all levels of the organisation. Executive level support enabled the training to be mandated, thereby ensuring staff attended training. 2. Conducting the initial stage of the project at one site enabled the project to be more easily managed in the early stages. 3. Public address announcements are felt to have boosted attendance. 4. Teaching craft-specific professional groups allowed the sessions to be tailored to those groups which increased staff engagement. 5. Creating a shortened version of the training for experienced senior medical clinicians who were time poor. 6. Support of the training from the Nurse Educators assisted with the site rollout following the initial phase.

Background
Effective clinical communication is essential in providing high quality safe patient care in the clinical setting. Failures in communication are recognised as a leading cause of adverse events (JCAHO,2006). Structured communication using a standardised tool can improve the quality of information exchange. Adapted from the SBAR tool (developed by the US Navy), the modified ISBAR is a very effective tool that provides a common and predictable structure to communication. Our Simulation Centre has successfully developed and incorporated the ISBAR communication tool into the final year medical students education program and as part of intern and the post graduate nurse orientation. A study evaluating the efficacy of this technique has concluded that: Training in the use of ISBAR is feasible, effective and likely to result in improved communication in the clinical environment (Marshall et al, 2009).

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Medical staff, in depth interview, evaluation of pilot.

  tisamostthoroughwayandhelps I identifyallthekeyaspectsthatyou aretryingtocommunicate

(Interviewee, Registered Nurse)

Aim
This project aimed to introduce ISBAR as a communication technique across Southern Health for internal telephone referrals within a clinical setting. Due to the size of the organisation, the project was divided into two phases, an initial phase based at one campus, followed by a second phase during which the project was rolled out site by site.

  ougetalltheinformationyou Y needitisalotquicker...andit promptsyoutoremember

(Interviewee, Clinical Nurse Specialist)

Acknowledgements Southern Health wish to thank VMIA for their support and encouragement throughout this project. References 1. Joint Commission on Accreditation of Healthcare Organisations (JCAHO). Sentinel event statistics, 2006. Available from www.jointcommission.org/sentinelevents/ statistics/ 2. Marshall. S, Harrison. J, Flanagan. B. The teaching of a structured tool improves the clarity and content of interprofessional clinical communication. Quality and Safety of Health Care. 2009;18(2):137-40 Contact Monica Finnigan Quality Practice Improvement Manager Southern Health monica.finnigan@southernhealth.org.au 9594 4038 or 0410 317 461

Methods
convened multidisciplinary committee with executive support developed face-to-face and online ISBAR education packages ISBAR training conducted by dedicated staff for all current & new clinical staff at pilot site, then rolled out across all campuses developed visual aids and tools to enhance training and prompt use communication strategy, included dedicated web page, email notifications, CEO newsletter, attendance at key clinician meetings, overhead PA announcements facilitated further applications of the tool incorporated in redesign of the Diagnostic Imaging request form development of Emergency Department to ward transfer form.

Conclusion
ISBAR is a simple yet effective tool that assists in standardising the manner in which clinical staff can communicate about patient care. The project has enjoyed moderate success in reaching the majority of staff in the initial phase of the project, and projections for the remainder of the project appear to be on track. Further evaluation of the whole project will follow. VMIA will assist in the promulgation of this initiative across other health services at the completion of the project.