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Skilled communication and respectful interaction among the health care team members are critical to achieve optimization of quality patient care outcomes. Accurate communication, particularly during clinical handoffs, is the focus of international, national, and local initiatives. Organizations such as the World Health Organization, World Alliance for Patient Safety, Institute for Healthcare Improvement, National Patient Safety Agency, Agency for Healthcare Research and Quality, and Australian Commission for Safety and Quality in Health Care have identified skilled communication during clinical handoffs as a priority.
In more than 2,900 sentinel events occurring in the United States, reported between 1995 and 2005, more than two thirds reported miscommunication as the root cause in their occurrence (Joint Commission on Accreditation of Healthcare Organizations, 2006b ). Sentinel events are defined as unexpected occurrences involving death or serious physical or psychological injury (Joint Commission on Accreditation of Healthcare Organizations, 2006b ). Such events are called sentinel because they signal the need for immediate investigation and response. Ineffective communication between nurses and physicians has been linked to medication errors, patient injuries, and patient deaths (Gurses & Carayon, 2007 ; Knaus, Wagner, Zimmerman, & Draper, 1993 ; Manojlovich & DeCicco, 2007 ). From 2004 to 2005, communication failures were a contributing factor in 25% to 41% of sentinel events in Australia (Australian Institute of Health and Welfare & the Australian Commission on Safety and Quality in Health Care, 2007 ; Wakefield, 2007 ).
In 2001, the Institute of Medicine (IOM) called for reform in communication norms, team performance, and risk assessment processes (IOM, 2001 ). Health care organizations worldwide must now implement a standardized approach to handoff communications (Joint Commission on Accreditation of Healthcare Organizations, 2006a ). Both the IOM and the Joint Commission endorse the application of a teamwork model developed by the U.S. military and the Federal Aviation Administration to provide clear, direct, unequivocal team communication (Mahlmeister, 2005 ). This teamwork model uses a structured communication tool called SBAR (S ituation, B ackground, A ssessment, and R ecommendation) defined in Table 1 . The SBAR technique provides a framework for communication among members of the health care team about a patient's condition during an urgent situation when information must be transmitted rapidly and...