SBAR with Numbers: Handover That Protects Patients in Gulf Private Care (Clinic · Ward · Home/Hotel/Yacht)

The SBAR template

S — Situation

• “Mr A. post-op day 1. Pain suboptimally controlled. No red flags.”

B — Background

• Procedure/date, key co-morbidities, allergies, current lines/drains, high-risk meds.

A — Assessment (with numbers)

• Vitals: HR 92, BP 118/70, RR 16, SpO₂ 96%, ETCO₂ 38 if monitored.

• Labs/imaging headlines (only what changes plan).

• Risks: OSA risk? Anticoagulation? Infection suspicion?

R — Recommendation (with numeric escalation lines + owner)

• “Increase analgesia per protocol; reassess in 30 min. Escalate to on-call MO if pain ≥7/10 after two steps, MAP <65, or SpO₂ <92% for >5 min. Runner: charge nurse.”

Rule: every R must contain at least two numeric triggers and a named owner of the next action.

Numeric lines you can reuse (signals, not promises)

• Respiratory: SpO₂ <92% for >5 min; ETCO₂ >50 or apnea ≥15 s → airway plan (jaw thrust → OPA/NPA → BVM) and call.

• Circulation: MAP <65; HR >130 or <50 with symptoms; new SBP drop >20% baseline.

• Neuro: new confusion/LOC; GCS drop ≥2.

• Bleeding: drain output >X mL/hr or bright blood → urgent review.

• Glycaemia: BG <4.0 mmol/L or >14 mmol/L with symptoms → protocol.
  Adjust to your unit’s standards and IFUs.

Examples by setting

Private clinic (procedural/infusion)

• “If ETCO₂ >50 or apnea ≥15 s, assist ventilation; if unresolved in 60 s → call crash team.”

• “If systolic <90 or >180 for >5 min despite initial measures → senior review.”

Hospital ward

• “If NEWS2 ≥5 or single parameter 3 → outreach/rapid response.”

• “If urine <0.5 mL/kg/h over 4 h in post-op day 0–1 → medical review.”

Home/Hotel/Yacht (domiciliary, VIP)

• “If SpO₂ <92% for 5 min, temp ≥38.5 unresponsive to antipyretic after 60 min, or uncontrolled pain ≥8/10 → transfer to named hospital via pre-agreed route.”

Documentation that stands up in committee

• Time-stamped SBAR with vitals and thresholds.

• Device IFU references for sedation/infusion where relevant.

• Medication safety: independent double-check (IDC) documented for insulin, anticoagulants, opioids, concentrated electrolytes.

Two checklists (ready to laminate)

Handover writer (30 seconds)

• Vitals entered with units

• Two numeric escalation lines written

• Owner of next action named

• High-risk meds IDC recorded

Handover receiver (15 seconds)

• Repeat back plan

• Confirm triggers and time box

• Know how to call help (extension/route)

Integrating with rota & privileges

• Rota must show escalation backup on every shift.

• Privilege list must match what’s implied (e.g., sedation monitoring in clinic).

• Insurance schedule must list settings (hospital/clinic/home/hotel/yacht) if your SBAR assumes domiciliary pathways.

Micro-audits (10 minutes, weekly)

1. Ten random notes: ≥2 numeric triggers present?

2. IDC documented where required?

3. Transfer notes include receiving hospital + route + ETA?

4. Any gap → one change adopted ≤14 days.

Red flags—and calm fixes

• Handover with no numbers → add two numeric lines before sign-off.

• Ambiguous ownership → assign by name/role, not “team.”

• Domiciliary SBAR but no rider/privileges → move care to clinic or fix coverage before visit.

Short FAQs