SBAR handover: how to use Situation, Background, Assessment, Recommendation (with a PLAB 2 example)
SBAR stands for Situation, Background, Assessment, Recommendation. The NHS England (NHS Institute for Innovation and Improvement) SBAR guide describes it as a structured way of communicating information that requires a response from the receiver, used to escalate a clinical problem that needs immediate attention or to hand over patients between clinicians. In a PLAB 2 handover or escalation station, SBAR lets you give a senior colleague the key facts, your assessment and a clear request within eight minutes.
Last checked Nov 1, 2026 against the NHS England SBAR guide and GMC pages listed under Sources.
The short version
- S, Situation: who you are, where you are calling from, which patient, and why you are calling now [1].
- B, Background: why the patient was admitted, relevant history, medicines, allergies and recent results [1].
- A, Assessment: vital signs and your clinical impression or concern. The NHS guide lists vital signs here [1].
- R, Recommendation: what you need, how soon, and your suggestions [1].
- Ask the receiver to read back the key points [1].
- If you don't know the diagnosis, say so: the guide suggests "I'm not sure what the problem is, but I am worried" [1].
- PLAB 2 scenarios last eight minutes and are marked in three domains, so the handover itself is assessed, not only your clinical knowledge [2][3].
What SBAR is, according to the NHS guide
The NHS England "SBAR implementation and training guide" was developed by the NHS Institute for Innovation and Improvement [1]. It describes SBAR as "an easy to remember mechanism you can use to frame communications or conversations" and says it can be used to escalate a clinical problem that requires immediate attention, or for efficient handover of patients between clinicians or clinical teams [1]. The guide lists uses for urgent and non-urgent, verbal and written communication, including emails, referral letters and handover [1].
Under Situation, the guide says to identify yourself and the site or unit you are calling from, identify the patient by name and the reason for your report, and describe your concern [1].
| Step | What the NHS guide says to include [1] | In a PLAB 2 station |
|---|---|---|
| S: Situation | Identify yourself, your unit and the patient; the reason for your call; the specific situation, including the patient's name, consultant, location, resuscitation status and vital signs | One or two sentences: who, where, why now |
| B: Background | Reason for admission, significant medical history, admitting diagnosis, date of admission, prior procedures, current medicines, allergies, relevant laboratory and other results | Only what helps the senior decide |
| A: Assessment | Vital signs; your clinical impressions and concerns. If you have no assessment, say you are worried | Your working diagnosis and how sick you think the patient is |
| R: Recommendation | Explain what you need, be specific about the request and time frame, make suggestions, clarify expectations | "Please come and review within..." and what you will do meanwhile |
| Readback | The receiver reads back a summary in the same SBAR format | Ask them to confirm; or read back their instructions yourself |
You may see vital signs given in Situation too: the guide's own description of Situation mentions them, and its Assessment section lists them [1]. In a phone escalation, give the one or two most worrying numbers in Situation and the full set in Assessment.
Worked example: escalating to the medical registrar
Example written by Confetto for practice. It is not a real PLAB 2 station, not a GMC sample, and not taken from the NHS guide. In practice, follow your hospital's escalation and bleeding protocols.
Candidate instructions (example): You are the F2 doctor on call for medical wards at night. The nurse on Ward 7 asked you to see Mr Robert Ellis, 66, admitted this afternoon with indigestion and tiredness. He has just passed a large black, tarry stool. You have assessed him. Call the medical registrar and hand over using a structured approach. You have eight minutes; the registrar may ask questions.
Your findings (from the station sheet, example): heart rate 118, blood pressure 92/60 (was 128/78 on admission), respiratory rate 22, oxygen saturation 96% on air, temperature 36.8°C, alert. NEWS2 score 6. Pale, clammy. Takes aspirin and ibuprofen for knee pain. No known liver disease. Hemoglobin on admission 112 g/L; repeat sent. You have put in two large-bore cannulas, sent bloods including a full blood count, kidney function, clotting and a group and save, and started IV fluids. He is for full escalation (no DNACPR decision recorded).
The handover (about 2 minutes of an 8-minute station)
S: Hi, this is Dr Osei, the F2 on call for medicine, calling from Ward 7. I'm calling about Mr Robert Ellis, 66, in bed 4, under Dr Morgan. I'm worried he has an upper GI bleed. He's just passed a large melena stool and he's tachycardic at 118 with a blood pressure of 92 over 60. He's for full escalation.
B: He was admitted this afternoon with indigestion and tiredness. He takes aspirin and regular ibuprofen for knee pain. No known liver disease and no previous bleeds. His hemoglobin on admission was 112.
A: On my assessment, his airway is fine and he's alert. Respiratory rate 22, saturations 96% on air, heart rate 118, blood pressure 92 over 60, down from 128 over 78, temperature normal. His NEWS2 is 6. He's pale and clammy. I think he has an upper GI bleed with early signs of shock. I've put in two large-bore cannulas, sent a full blood count, kidney function, clotting and a group and save, and started IV fluids.
R: I'd like you to come and review him now, please. I think he may need a blood transfusion and an urgent endoscopy, and I'd value your help with both. In the meantime I'll repeat his observations every 15 minutes, chase the hemoglobin, and contact the blood bank about crossmatching blood. Is there anything else you'd like me to do before you arrive?
Registrar (role-player): I'll be there in 10 minutes. Crossmatch four units and keep him nil by mouth.
Readback: So you'll come in 10 minutes. In the meantime I'll crossmatch four units, keep him nil by mouth, repeat observations every 15 minutes and chase the hemoglobin. Is that right?
The rest of the station is usually the registrar's questions ("What's his Glasgow-Blatchford score?", "Is he on anticoagulants?"). Answer what you know, say plainly what you don't, and offer to find out.
What scores in each domain (labelled practice breakdown)
Sample breakdown written by Confetto for practice. It is not the GMC marking sheet.
| GMC domain | Strong performance | Weak performance |
|---|---|---|
| Data gathering, technical and assessment skills | Gave the key numbers, the trend (blood pressure falling), the relevant drugs (aspirin, ibuprofen), resuscitation status | Read every observation in random order; missed the NSAIDs; no trend |
| Clinical management skills | A clear working diagnosis, appropriate first steps already done, a specific request with a time frame, a plan for the meantime | "Could you come and see him at some point?"; nothing done before calling; no plan |
| Interpersonal skills | Introduced self and location, concise, confident, asked if anything else was needed, read back the instructions | Long, disorganized story; apologetic and vague ("sorry to bother you, he's maybe not great"); no readback |
SBAR template
Copy this for practice or for real escalation calls.
S Situation I am [name], [grade], calling from [ward/unit]. I am calling about [patient name, age], [bed/location], under [consultant]. The problem is [one sentence]. Most worrying sign: [e.g. BP 92/60, HR 118]. Resuscitation status: [for full escalation / DNACPR / ceiling of care]. B Background Admitted [when] with [reason]. Relevant history: [ ]. Medicines: [relevant ones]. Allergies: [ ]. Recent results: [ ]. A Assessment Observations: RR [ ], SpO2 [ ] on [air/O2], HR [ ], BP [ ], temp [ ], consciousness [ ]. Early warning score: [ ]. I think the problem is [working diagnosis], OR: I'm not sure what the problem is, but I am worried. I have already done: [ ]. R Recommendation I would like you to [come now / within X minutes / advise by phone]. Meanwhile I will [ ]. Is there anything else you'd like me to do? Readback So the plan is [ ]. Is that right?
SBAR for end-of-shift handover
The same structure works for a handover to the next doctor. For each patient you hand over: Situation (who, where, the problem tonight), Background (why they are in, key history), Assessment (how they are now, what is outstanding), and Recommendation (what the next doctor needs to do and when, and what to escalate). Put the sickest patients first, and say clearly what jobs are outstanding.
Common mistakes in handover stations
| Mistake | Better |
|---|---|
| Starting with the full history ("He was admitted three days ago...") | Start with Situation: who you are, who the patient is, why you are calling now |
| No clear request | Say exactly what you need and how soon |
| Giving numbers without meaning | Add the trend and your interpretation ("BP 92/60, down from 128/78") |
| Hiding uncertainty | "I'm not sure what the problem is, but I am worried" is a valid assessment [1] |
| Not saying what you have already done | List the actions taken so the senior doesn't repeat them |
| No readback | Read back the senior's instructions, or ask them to confirm |
| Forgetting resuscitation status | Include it in Situation [1] |
Practice this station
Confetto isn't affiliated with the GMC.
Frequently asked questions
What does SBAR stand for?
Situation, Background, Assessment, Recommendation [1].
Where do vital signs go in SBAR?
The NHS England SBAR guide lists vital signs under Assessment, and its description of Situation also mentions them [1]. A practical approach is to give the most worrying number in Situation and the full set in Assessment.
What if I don't know what's wrong with the patient?
Say so. The NHS guide suggests that if you don't have an assessment you can say "I'm not sure what the problem is, but I am worried" [1].
What is readback in SBAR?
After the conversation, the receiver reads back a summary of the information in the same SBAR format, to make sure it was understood correctly [1].
Is SBAR required in PLAB 2?
The GMC pages we read don't name SBAR or any handover tool. Each PLAB 2 scenario is marked in three domains (data gathering, clinical management and interpersonal skills), and a structured handover helps with all three [3].
Can SBAR be used in writing?
Yes. The NHS guide says it can be used for verbal or written exchanges, including emails and letters such as referral letters [1].
Sources
Read on November 1, 2026.