Handoff Tools & Protocols

SBAR Framework:

- S – Situation: What is happening now?

- B – Background: What is the relevant history?

- A – Assessment: What do I think the problem is?

- R – Recommendation: What do I suggest? (Choi & Chang, 2023)

I-PASS Framework:

- I – Illness severity: Stable, watcher, or unstable.

- P – Patient summary: Summary statement, events, diagnosis, treatment plan.

- A – Action list: To-do items.

- S – Situation awareness & contingency planning: What could go wrong, and what to watch for.

- S – Synthesis by receiver: Receiver repeats back critical information (Starmer et al., 2014).

Why Use Both?

- SBAR is simple and widely adopted in nursing practice, especially in high-turnover settings like the ED (Rhudy et al., 2022).

- I-PASS provides a more detailed, physician-led framework shown to reduce medical errors by 23% in multicenter trials (Starmer et al., 2014).

- Hospitals may adopt hybrid models, using SBAR for quick verbal handoffs and I-PASS for shift-change or interdisciplinary transitions (Gross, Salas, & Weaver, 2025).

Case Example:

A missed antibiotic order in the ED due to incomplete SBAR handoff resulted in treatment delay and harm. Adding I-PASS structure (e.g., Action List and Synthesis by Receiver) could have prevented the omission (Joint Commission, 2023).

Nurses can apply these tools during shift changes, transfers to inpatient units, and consultations with physicians. Structured protocols improve efficiency, reduce preventable errors, and support a culture of safety.