Why numbers change behaviour
SBAR works when R = Recommendation contains measurable triggers. “Escalate if unwell” creates drift; “Escalate if SpO₂ <92% for 5 min or MAP <65” creates action. Numeric lines let nurses, doctors and physiotherapists move fast without noise—vital in VIP/UHNWI care and small clinic rooms.
Copy-paste SBAR template (with numeric lines)
“Mr A., 58, post-op day 1 in Room 7—increasing oxygen needs.”
“Laparoscopic cholecystectomy; HTN; IV fluids 100 ml/h; on PCA.”
“RR 26, SpO₂ 91% on 4 L, HR 108, BP 102/64, pain 7/10, temp 37.9°C.”
“Increase to 6 L; ABG now; call medical lead if SpO₂ <92% for 5 min, RR >30, or MAP <65; hold PCA if sedation score ≥3.”
Unit-specific examples (plain English)
ICU/High-Acuity
Ventilated patient: “Escalate if Pplat >30, pH <7.25, SpO₂ <90% despite FiO₂ ↑.”
Electrolytes: “Stop infusion and call if K⁺ >5.5 or arrhythmia appears.”
Inpatient wards
Sepsis watch: “Escalate if NEWS ≥5 or lactate >2; blood cultures before antibiotics.”
Anticoagulation: “Heparin drip—call if aPTT >100 s or active bleeding.”
Physiotherapy / Mobilisation
“Pause and escalate if HR >130, SpO₂ <92%, SBP <90, new neuro deficit, or chest pain.”
Ambulatory/Private clinics
Procedure room: “Stop and escalate if SBP >180 or SpO₂ <92% after 5 min recovery.”
Documentation that proves reliability
Handover note contains time, names/roles, SBAR lines and explicit thresholds.
MAR/flowsheet shows the same numbers; avoid conflicting triggers.
If thresholds change, update the care plan and the unit board the same hour.
VIP/UHNWI nuance (privacy without shortcuts)
Same SBAR, quieter delivery. Use neutral language in semi-public areas; no names in corridors, lifts, docks or marinas.
Family updates flow through the medical lead only. Household PA/security coordinate logistics, not clinical decisions.
Making SBAR stick (10-minute unit drill)
Pick one active case; nurse leads a 60-second SBAR with thresholds; doctor confirms/edits numbers; physiotherapist adds mobilisation triggers.
Snapshot the note; charge nurse checks two charts later that day for numeric lines present.
Manager micro-audits (weekly, fast)
Two random handovers show numeric escalation lines.
At least one physiotherapy note includes STOP triggers.
Any near-miss this week? ≤72-hour huddle completed with one change adopted.
Unit board lists the escalation tree for the next 7 days.
Pump/IFU step most often missed is pinned in the workroom.
Common pitfalls—and calm fixes
Vague “call if worse” language → replace with two numeric triggers.
Different thresholds in EMR vs whiteboard → update both immediately; one owner.
Over-complex lines → keep 2–4 triggers max; staff must recall them under pressure.
No ownership → write the name/role responsible for acting on the trigger.