Raise the S-BAR and Lower the Risk

          A crucial key to preventing acute care readmissions from the Post-Acute Care setting is the use of clear and comprehensive communication between nurses and physicians.
A few years ago while working in my office as Director of Skilled Nursing, I overheard a nurse speaking on the phone with a physician indicating that her patient was short of breath. No additional information was communicated during the call. The nurse then proceeded to dial 9-1-1 to send the patient to the nearest hospital. When I inquired why the patient was being sent out emergently, the nurse replied that the patient was short of breath and the physician wanted her sent to the Emergency Room.
          With my stethoscope in-hand, I went directly to the patient’s room to perform a physical assessment. My findings were as follows: the patient was alert and oriented; auscultation of her lungs indicated rales/crackles in her left lobe; she had a productive cough; pulse ox on room air was 90%; oral temperature was 101 degrees Fahrenheit; and respiratory rate was 28 per minute. All signs seemed to point to a developing pneumonia for which I believed the patient would benefit from a chest x-ray and blood work to rule out infection. I contacted the patient’s physician again and communicated the assessment and recommendations using a proven tool known as the SBAR (Situation, Background, Assessment, Recommendation). The physician was in agreement and results of testing indicated the patient had a developing left lower lobe pneumonia with an elevated WBC (white blood count) indicating infection. The physician ordered an intravenous antibiotic, and the patient was treated successfully in the skilled nursing facility, avoiding an unnecessary emergency room trip and admission to the hospital.
          As a Director of Nursing, I immediately established additional assessment training for nursing staff and instituted the use of the SBAR tool for all nurse/physician communication. Acute care readmissions were reduced from 24% to less than 16%. Physicians expressed more confidence in the assessments provided to them by nursing staff, and patient satisfaction with nursing knowledge (as measured on a satisfaction survey) improved steadily.
          This real-life case indicates how important it is for nurses to properly collect and communicate clinical information to physicians so that appropriate decisions can be made collaboratively for the benefit of the patient.
          Not only did the confidence level of our nursing and physician staff improve, but hospital referral sources were also more likely to send patients from their hospitals because they were able to avoid readmission penalties mandated by the Affordable Care Act. 
          Great nursing skill combined with effective communication using the SBAR tool leads to fewer patient complications, improved patient satisfaction and increased referrals and revenue.