Perception of the Handover Communication with Situation, Background,

Assessment, Recommendation (SBAR) at the Ummi Hospital, Bogor City,

Indonesia

Diah Setyaningsih

, Wahyu Sulistiadi

and Al Asyary

Department of Health Administration and Policy, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia

Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia

*Corresponding author

Keywords: Handover Communication, Primary Care, SBAR, Patient Safety

Abstract: Handover communication, that recommended by WHO, has the purpose of ensuring the continuity and

safety of the patient's care. The success of patient treatment increases with the success of handover with

Situation, Background, Assessment, Recommendation (SBAR) method in some relevances settings which

emerged a question whether it will succeed in various setting. This study aims to know the perceived of

handover communication with the SBAR method, including its perception with the work environment,

safety behavior, and supervision in the Ummi Hospital of Bogor, Indonesia.vThe qualitative approach was

conducted with a semi-structured questionnaire to enhance the study aimed. The subject was all nurses and

midwives in the Emergency Unit, Inpatient Unit, ICU, NICU/PICU, Delivery Unit and Operating Room (n

= 71). In general, the medical staffs in the ED of Ummi Hospital of Bogor City had awareness about the

importance of communication during handover, although it has not yet implemented in all daily duty

activity. All of the subjects agreed that SBAR made the handover communication happens with

understandable language to all nurses and midwives, with 61.9% agreeing that it was easy to use as it uses a

short sentence. Meanwhile, there 90.9% of nurses and midwives agreed to use language with a sentence that

mentions the main points.vAlmost medical staffs perceived that the handover communication with SBAR

would be useful in those variables. It is essential to foster any efforts to well-implemented this approach in

daily activity at the Ummi Hospital of Bogor.

1 INTRODUCTION

Handover (also called handoff) is an interactive

process of transferring patient-specific information

from one caregiver to another or one care team to

the next care team with the aim of ensuring the

continuity of the patient's care and security process

(Patton et al., 2007). The handover process has a

major impact on the continuity of care and patient

safety Ministry of Health, 2017). The quality of

handover becomes very important because the poor

handover can lead to inappropriate treatment, delays

in diagnosis, additional hospitalization time and

patient and nurse dissatisfaction (Thomson,2015).

One of the service units in hospitals that have crucial

handover is the Emergency Department.

Emergency Department (ED) have unique

characteristics with handover communication that

cannot be predicted due to having a fast patient flow

and an increasing number of patients in a short time.

This situation also puts great pressure on the nurses

in charge (Healy et al., 2011). It found that the

quality of handover increased in the ED as the

patient inflows slowed, the nurse had a good

experience, a comfortable situation and a good

relationship between the nurse giving and receiving

the patient when taking care (Thomson,2015). The

success of communication handover is influenced by

physical environmental factors, social, language

barriers, communication media (Solet et al., 2005),

as well as the ability of nurses (Foster-Hunt et al.,

2015;Santana et al., 2018).

Situation, Background, Assessment, and

Recommendation (SBAR) method is a standard

communication procedure made by clinical staff at

the Kaiser Permanente Organization in Colorado,

United States (Institute for Healthcare Improvement

Setyaningsih, D., Sulistiadi, W. and Asyary, A.

Perception of the Handover Communication with Situation, Background, Assessment, Recommendation (SBAR) at the Ummi Hospital, Bogor City, Indonesia.

DOI: 10.5220/0009858800560063

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 56-63

ISBN: 978-989-758-469-5

SBAR,2014). SBAR is officially recommended by

WHO as an effort to improve the quality of

handover communication that leads to patient safety.

For nurses who give over to take care of transferring

the SBAR method, the nurse accepts to take care of

listening, checking in the transfer paper guard,

taking notes and asking questions that are not clear

to the nurse giving the guard. Handover can also

involve the patient's family waiting for the patient by

asking the patient's family about additional

information that the nurse may not yet know (Herm-

Barabasz, 2015).

Based on the published official report, the Ummi

Bogor Hospital ED had not implemented the

standardized handover communication yet before.

Currenty, the hospital declares and start to

implement this method in their handover

communication as well as in their workflow

activities including in the ED department. At

present, the Bogor Ummi Hospital ED consists of 12

nurses and 1 midwife, 8 of whom have certified as

Basic Trauma Cardiac Life Support (BTCLS) care.

Although some nurses have received effective

handover training, the implementation has not been

implemented according to several factors. Therefore,

this study explores the working environment, safety

behavior, and supervision aspects of the effectivity

of communication handover at the Ummi Hospital of

Bogor City, Indonesia.

2 MATERIAL AND METHODS

This study used the SBAR method with the

qualitative approach with semi-structured

questionnaire for all nurses and midwives in the ED,

Inpatient Installation, ICU, NICU/PICU, Maternity

Room, and Ummi Bogor Hospital Operation Room

(n = 71). Validity and reliability of questionnaire

assessed by Cronbach's alpha test for reliability,

while the correlated item-total correlation for

validity test. Multiple linear regression was

conducted to analyze the correlation adjusted on

communication handover at the ED of the Ummi

Bogor hospital, Bogor City, Indonesia.

The study was conducted after obtaining approval

from the University of Indonesia's Public Health

Faculty Research Ethics Committee and Public

Health Service with letter number:

579/UN2.F10/PPM.00.02/2017 dated 21 November

2017.

3 RESULT

It shows that all of nurses and midwives at the ED of

Ummi Bogor agreed to use understood language to

their comrades, while 61.9% agreeing to use a short

sentence. A total of 90.9% of nurses and midwives

agreed to use language with a sentence that mentions

the main points in the handover in accordance with

the SBAR sequence order and as many as 70.9% of

nurses agree to take notes with short sentences as

handover documentation (Table 1).

Table 1. Perceived of the Handover Communication with SBAR at the ED of Ummi Hospital in Bogor

No Statement

Scoring

Strongly

agree

Agree Doubtful Disagree

Strongly

Disagree

Handover Communication

A Language

The language used in the handover

communication at Ummi Bogor Hospital

is a language that is understood by all

clinical staff

26 (47.3%) 29

(52.7%)

- - -

It used a short sentence, 9

(16.4%)

(45.5%)

(14.5%)

(23.6%)

The sentence used, mentions the points

to be taken in accordance with the order

of SBAR

20 (36.4%) 30

(54.5%)

(7.3%)

(1.8%)

Recorded with short sentences as

documentation handover

13 (23.6%) 26

(47.3%)

(14.5%)

(12.7%)

(1.8%)

Perception of the Handover Communication with Situation, Background, Assessment, Recommendation (SBAR) at the Ummi Hospital,

Bogor City, Indonesia

No Statement

Scoring

Strongly

agree

Agree Doubtful Disagree

Strongly

Disagree

B Standard Method

The current handover procedure at the

Ummi Bogor Hospital has been carried

out according to the SBAR standards I

learned

10 (18.2%) 34

(61.8%)

(18.2%)

(1.8%)

If there is an unclear sentence according

to the recipient nurse, the nurse who gave

over the care shall repeat the sentence

24 (43.6%) 30

(54.5%)

(1.8%)

- -

The implementation of the SBAR

standard method makes it easier for me

to work

14 (25.5%) 38

(69.1%)

(5.5%)

- -

The SBAR method makes me focus on

efforts to improve patient safety

14 (25.5%) 38

(69.1%)

(5.5%)

- -

There was 80% of nurses and midwives agreed that

the handover procedure at the ED of Ummi Bogor

Hospital had been carried out according to the method of

SBAR method, and 94.6% agreed that the handover

method made their work easier. When handover happened,

if there is a sentence that is unclear according to the nurse

or midwife of the handover recipient, 98.1% of nurses and

midwives who give handover agreed to repeat the

sentence. As many as 94.6% of respondents agreed that

the handover method with SBAR can make them more

focus on efforts to improve patient safety (Table 2).

Table 2. Perceived of the Handover Communication with SBAR to Work Environment, Safety Behaviors, and Supervision

at the ED of Ummi Hospital in Bogor

No Statement

Scoring

Strongly

agree

Agree Doubtful Disagree

Strongly

Disagree

Work Environment

A Physical Environment

The job support tools have been complete 8 (14.5%) 18

(32.7%)

11 (20%) -

Tools have been placed according to safety

rules

6 (10.9%) 25

(45.5%)

(40%)

(3.6%)

It held periodic tool checking/calibration 7 (12.7%) 26

(47.3%)

(32.7%)

(7.3%)

If there is damage, it quickly replaced 6 (10.9%) 21

(38.2%)

(34.5%)

(9.1%)

4 (7.3%)

Laboratories support the work adequately 3

(5.5%)

(50.9%)

(32.7%)

(10.9%)

Pharmacy installations support the work

adequately

(5.5%)

(52.7%)

(34.5%)

(7.3%)

Radiology installations support the work

adequately

(5.5%)

(49.1%)

(23.6%)

11 (20%) 1 (1.8%)

B Psychic Environment

I have a reward if I get an achievement at my

job

6 (10.9%) 19

(34.5%)

(43.6%)

(7.3%)

2 (3.6%)

I have leeft that according to the Ministry of 17 (30.9%) 31 7 - -

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

No Statement

Scoring

Strongly

agree

Agree Doubtful Disagree

Strongly

Disagree

Manpower's provisions. The right to leave

for employees according to Law no. 13 of

2003 concerning Manpower, namely in the

form of annual leave, maternity leave, leave

if sick and leave due to important needs

(56.4%) (12.7%)

I have enough rest time 8 (14.5%) 26

(47.3%)

(30.9%)

(7.3%)

I have enough worship opportunities 17 (30.9%) 32

(58.2%)

(7.3%)

(1.8%)

1 (1.8%)

I have a salary according to workload 8 (14.5%) 15

(27.3%)

(38.2%)

(18.2%)

1 (1.8%)

C Social environment

I have a clear career path according to the

achievement

7 (12.7%) 18

(32.7%)

(41.8%)

(10.9%)

1 (1.8%)

If there is a dispute, it is settled in a familial

manner

12 (21.8%) 32

(58.2%)

(18.2%)

(1.8%)

My co-worker is willing to help if I

experience difficulties

16 (29.1%) 35

(63.6%)

(5.5%)

(1.8%)

Safety Behavior

Standard Operating Procedure

SOP already exists in the unit where I work 10 (18.2%) 31

(56.4%)

(23.6%)

(1.8%)

I understand the SOP that applies in my work

unit

9 (16.4%) 33

(60%)

(21.8%)

(1.8%)

I obey the SOP in my work unit 9 (16.4%) 36

(65.5%)

(16.4%)

(1.8%)

SOP helps simplify my work 8 (14.5%) 43

(78.2%)

(5.5%)

(1.8%)

SOP evaluation is carried out according to

the development needs in my work unit

(20%)

(54.5%)

(21.8%)

(3.6%)

B Patient Safety

My education matches with the unit I work

for

24 (43.6%) 27

(49.1%)

(7.3%)

- -

When handover, I identified the patient next

to the patient him/herself

16 (29.1%) 32

(58.2%)

(9.1%)

(3.6%)

When handover, I mentioned the patient's

disease history

16 (29.1%) 36

(65.5%)

(1.8%)

(3.6%)

When handover, I mentioned the results of

my patient's examination

18 (32.7%) 34

(61.8%)

(1.8%)

(3.6%)

When handover, I mentioned the need for

patient care which needed

15 (27.3%) 34

(61.8%)

(10.9%)

- -

I apply the informed consent before taking

the medical care

29 (52.7%) 26

(47.3%)

- - -

Safety signs are complete 7 (12.7%) 19

(34.5%)

(49.1%)

(3.6%)

I always make sure the patient's warning

signs are clearly read

7 (12.7%) 28

(50.9%)

(32.7%))

(3.6%)

Perception of the Handover Communication with Situation, Background, Assessment, Recommendation (SBAR) at the Ummi Hospital,

Bogor City, Indonesia

No Statement

Scoring

Strongly

agree

Agree Doubtful Disagree

Strongly

Disagree

The safety line is clear 1

(1.8%)

(49.1%)

(45.5%)

(3.6%)

Floor tight (not slippery) 8 (14.5%) 37

(67.3%)

(16.4%)

(1.8%)

The floor is easy to clean 9 (16.4%) 40

(72.7%)

(10.9%)

- -

When there is contamination (vomiting,

blood or other contaminants) the cleaning is

done immediately by the officer

12 (21.8%) 31

(56.4%)

(18.2%)

(3.6%)

C Code of Conduct

Regulations at the Ummi Bogor Hospital

were carried out in an orderly manner

13 (23.6%) 34

(61.8%)

(12.7%)

(1.8%)

I have a warning when breaking the rules 11

(20%)

(78.2%)

- 1

(1.8%)

Shift changes are done on time 13 (23.6%) 27

(49.1%)

(20%)

(7.3%)

Working hours are in accordance with the

applicable rules

19 (34.5%) 28

(50.9%)

(12.7%)

(1.8%)

Shifting happens in regularly 18 (32,7%) 29

(52.7%)

(14.5%)

- -

Exchange of shift schedules for team

members is reported to the coordinator

20 (36.4%) 31

(56.4%)

(7.3%)

- -

Supervision

A Leadership

There is a person in charge of each handover

team

18 (32.7%) 34

(61.8%)

(5.5%)

- -

There is a clear work division among the

handover team members

18 (32.7%) 26

(47.3%)

(18.2%)

(1.8%)

Each member of the work team can propose

the progress of the handover team

10 (18.2%) 39

(70.9%)

(10.9%)

- -

Team members involved in the decision

making of the handover team

13 (23.6%) 34

(61.8%)

(14.5%)

- -

The leader of the team ensures that the

patient's standard needs are carried out on

demand

12 (21.8%) 33

(60%)

(16.4%)

(1.8%)

B Monitoring

The hospital management supervised the

handover

6 (10.9%) 31

(56.4%)

(27.3%

(5.5%)

Periodic evaluation of handover is carried

out by management

7 (12.7%) 31

(56.4%)

(29.1%)

(1.8%)

Periodic training of handover is carried out 9 (16.4%) 27

(49.1%)

(32.7%)

(1.8%)

The hospital conducts a comparative study to

another hospital about the handover

procedure

(5.5%)

(50.9%)

(34.5%)

(9.1%)

The investigation is carried out if an error

handoff is found

(20%)

(61.8%)

9 (16.4%) 1

(1.8%)

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

4 DISCUSSIONS

Initially, the SBAR communication method adopts

communication procedures in the United States

Navy which composes effective communication in

the US submarine industry. The soldiers use the

SBAR method which can be effectively used for all

people at all levels, with structured communication

(Narayan,2013). In its development, the basic

pattern of SBAR can be adapted to existing needs,

such as the replacement of the treating physician or

the discussion of the patient's condition. The

previous study states that the use of standardized

communication through the SBAR method is able to

create a safe atmosphere and decrease the incidence

of accidents due to communication disruptions

(Randmaa,2016).

Others studies also stated that the existence of

standard standards can make communication over

guard more smoothly. (Cheung et al.,2010;Cohen et

al., 2010;Asyary et al., 2013). Handover

communication is called effective communication as

seen from the outcome that is in the form of

certainty and continuity of uninterrupted treatment

seen from the patient's medical record (WHO,2007).

In this study, handover communication is seen from

the perception of nurses and midwives because

perception is the result of one's knowledge.

Perception includes passive behavior as well as

thinking and opinion, depending on the objective of

the workflow and the actors involved (Santana et al.,

2018). In this case, the perception of nurses

examined through questionnaires was the result of

knowledge possessed by nurses and midwives, after

receiving training (Agiviana,2015). Handover

communication is considered effective based on the

standard language and method, that is, if the

language is neatly arranged, the contents of the

content are kept the same and the standard method

of SBAR is applied in an effort to improve patient

safety(Thomson,2015;Cheung et al.,2010;Ellis et al.,

2003).

Other studies have previously stated that

relationships in teamwork (relationship), job stress,

fatigue and standard procedures over guarding affect

handover communication (Thomson,2015). The

leadership factor in the work team as the concept of

the System Migration Model has stated that

handover communication in the team is not only to

explain the needs and conditions of the patient but

also to make important decisions in determining the

necessary steps of care (Cornell et al., 2014). The

nurse leadership attitudes in terms of patient safety

are significantly related to staff perceptions of

patient safety culture (Drake,2015). Lack of

responsibility sense, language barriers, ability to

well communicate factors also become variables that

influence the occurrence of failure handover

Quattrin et al., 2014).

This study finding shows that all of nurses and

midwives in the ED of Ummi Hospital Bogor agreed

to use language understood by all nurses and

midwives, with 61.9% agreeing to use a short

sentence. This gap in approval rate shows that not all

nurses and midwives agree that language that is easy

to understand is a short language. In its application,

there is a short variation of sentence length

according to the perception of each respondent. If it

is related to the results in the same finding that

90.9% of nurses and midwives agree to use language

with a sentence that mentions the points to keep in

accordance with the sequence order of SBAR. It can

be concluded that most respondents use

communication in an easy to understand language

with varying sentence lengths but contains the points

of handover in accordance with the sequential order

of Situation, Background, Assessment,

Recommendation.

There was 70.9% of respondents agreed to write

a record of short sentences as handover

documentation. These results indicate that

respondents realize that the use of the standard

method of overseeing SBAR as a handover method

through verbal conversation must be supported by

writing a record as part of the documentation. In

fact, several of the patient's information was lost in

the event of a transfer of care in the ED caused by

communication that was not running well and

structured (Bennett et al., 2016). The mistake of

handover at the ED does not only cause treatment

results which are not optimal but also results in the

patient losing medical history information that will

be useful in the future. Procedure improvement

through the use of standard procedures is a solution

to facilitate the handover process.

The use of standardized communication through

the SBAR method is able to create a safe atmosphere

and decrease the incidence of accidents due to

communication disruptions (Randma,2013). SBAR

is the best method that contains critical information

about patients that can be well drawn up and

consistent at all times (Warrier, 2011).SBAR brevity

is useful to go directly to the main points of

information so that communication becomes

directed. Although the main principle of

communication is very simple, which starts from the

ability to hear and understand the interlocutor rather

than talking and trying to convince the other person

Perception of the Handover Communication with Situation, Background, Assessment, Recommendation (SBAR) at the Ummi Hospital,

Bogor City, Indonesia

(Tunajek, 2010). in practice, there are many factors

that can become inhibitors, such as stress and lack of

standard procedures (Cheung et al., 2010). SBAR

standard procedures make it easier to carry out the

handover by making restrictions and directions of

conversation so that information can be handed over

appropriately (Anselm,2017)

5 CONCLUSION

This study revealed that the SBAR method, that

implements to support a better work environment,

safety behavior, and supervision has make better

handover communication. Safety behavior shows the

consistency perception about the handover

communication with SBAR influence in order to

achieve patient safety at the primary care. However,

all medical staff has not yet implemented this issue

on their daily duty all activity. It is essential to

overlook these variables with quantitative approach

to discover the validity of relationship significances

as well as fostering the method by well-structured

training and information from databases in primary

care in the further studies.

FUNDING

No grant support or funding from public institutions

or private enterprises was received for this case

report.

ACKNOWLEDGMENTS

This study was the part of the Master of Hospital

Administration (MARS) thesis in Hospital

Administration Study at the Faculty of Public

Health, Universitas Indonesia which funded by

Directorate for Research and Community Services,

Universitas Indonesia (DRPM-UI). We would like to

thank all parties: all staff in Ummi Hospital of Bogor

City and all lecturers of Hospital Administration

Program at the Faculty of Public Health, University

of Indonesia.

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Perception of the Handover Communication with Situation, Background, Assessment, Recommendation (SBAR) at the Ummi Hospital,

Bogor City, Indonesia