Implementing SBAR to Facilitate Communication and Improve Transitions Between Inpatient and Outpatient Behavioral Healthcare Services

Background: The purpose of this quality improvement project was to implement the Situation Background Assessment and Recommendation (SBAR) communication tool in an inpatient psychiatric facility (IPF) to improve transitions of care for veterans. Ineffective hand-offs contribute to adverse events, delay treatment, and increase readmission rates after 30 days of discharge. The lack of standardized transition tools during hand-offs creates potential communication gaps, whereas the SBAR framework facilitates transitions and improves patient care and safety. Comparatively, effective hand-offs communication establishes a smooth transition of care from one clinician, facility, or team member to another. Effective management of patient transitions and standardization of hand-offs practices promote consistent communication, reduce unnecessary readmission and medication errors, and improve follow-up. Methods: A quality improvement project was developed to enhance communication during transitions of care for veterans. Discharge guidelines from an IPF were compared against The Joint Commission (TJC) standards, and IPF staff members were assessed to determine their foundational knowledge of SBAR and hand-offs communication. An educational IPF in-service with posters and a brochure was developed and presented to IPF staff members. The in-service included an overview of SBAR, case scenarios involving transitions of care, and role-play using the SBAR form. The Transition of Care (TOC) pharmacist receiving SBAR assessed hand-offs and described the process for transfers of care based on descriptive statistics.Results: The IPF adhered to many of the TJC discharge guidelines. However, a considerable was gap identified between TJC discharge goals and the hospital's discharge procedures, namely a lack of pharmacy representation. Results from the educational SBAR hand-off staff training included an equal number of pre- and post-survey, with 32 participants. Survey results indicated that staff's foundational knowledge of SBAR increased from 31% pre-in-service to 88% post-in-service (p< .001). Post-in-service, all participants (100%) correctly identified the meaning and importance of hand-off communication using SBAR. The TOC pharmacist's qualitative analysis of 15 SBAR forms with 8 hand-offs calls using SBAR for psychiatric purposes highlighted several areas for improvement. Findings revealed inconsistencies in SBAR information reported on hand-off call versus printed instructions for the patient. The TOC pharmacist noted effective disposition planning, enhanced exchange of critical information, and having an active liaison improved transitions related to follow-up care and medication.Conclusion: Results demonstrate that SBAR hand-off training and pharmacist involvement were effective in improving the quality of care and patient safety during completed transitions. The TOC pharmacist's phone calls during hand-offs contributed to successful medication reconciliation, promoted exchange of crucial information, and improved veteran communication between IPF and outpatient behavioral services. The study encountered barriers to implementation in the form of lack of IPF administration support, demonstrating that implementing SBAR throughout the IPF would require a commitment from all organizations involved in transitions. Lastly, TJC already has a robust hand-off online Transforming Solution Tool that addresses many of the issues encountered; therefore, recommendations include consideration to the utilization of these materials.