Effectiveness of ISBAR Protocol Implementation by Emergency Medicine Residents in Pediatric Handovers; A Pre-post Intervention Study
Archives of Academic Emergency Medicine,
Vol. 13 No. 1 (2025),
6 September 2025
,
Page e75
https://doi.org/10.22037/aaem.v13i1.2835
Abstract
Introduction: Effective information transfer between healthcare providers is essential for patient safety. This study aimed to evaluate the impact of ISBAR (Identify, Situation, Background, Assessment, Recommendation) framework on the quality of clinical handovers in emergency department (ED).
Methods: This prospective, pre- and post-intervention study was conducted at Hazrat Ali Asghar Pediatric Hospital in Tehran, Iran, from May to September 2023. A total of 428 clinical handovers were recorded (214 pre-intervention and 214 post-intervention) following a 90-minute training session and the introduction of a standardized ISBAR checklist. Handover quality was measured using the completeness of a 16-item ISBAR checklist. Data analysis employed descriptive statistics, the Mann–Whitney U test, and Chi-square tests.
Results: Implementation of the ISBAR protocol significantly improved the overall quality of information conveyed during handovers. Total handover scores increased from a mean rank of 127.55 pre-intervention to 301.45 post-intervention (P < 0.001). All five ISBAR domains showed significant enhancements; Identify (from 145.41 to 283.59, P=0.001), Situation (from 129.64 to 299.36, P=0.001), Background (from 136.40 to 292.60, P=0.001), Assessment (from 156.00 to 273.00, P< 0.001), and Recommendations (from 198.14 to 230.86, P=0.03). In addition, the completeness of individual items such as patient diagnosis, admission date, and vital signs improved markedly.
Conclusions: Adopting a standardized ISBAR handover protocol in a high-stakes pediatric environment ED significantly enhances the accuracy and completeness of patient handovers, thereby reducing the potential for errors and strengthening patient safety.
- handoffs
- ISBAR
- patient safety
- patient’s transfer
- standardized tools
- Quality improvement
How to Cite
References
Day R, Lambert J, Lee KL. Improving Transfer of Patient Care Information Between OBGYNs and Pathology Department [23E]. Obstetrics & Gynecology. 2017;129(5):58S.
Burgess A, Van Diggele C, Roberts C, Mellis C. Teaching clinical handover with ISBAR. BMC medical education. 2020;20(Suppl 2):459.
Clapper TC, Ching K. Debunking the myth that the majority of medical errors are attributed to communication. Medical education. 2020;54(1):74-81.
Ahmed J, Mehmood S, Rehman S, Ilyas C, Khan L. Impact of a structured template and staff training on compliance and quality of clinical handover. International Journal of Surgery. 2012;10(9):571-4.
Weller J, Torrie J, Boyd M, Frengley R, Garden A, Ng W, et al. Improving team information sharing with a structured call-out in anaesthetic emergencies: a randomized controlled trial. British journal of anaesthesia. 2014;112(6):1042-9.
Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian journal of anaesthesia. 2016;60(7):451-7.
Van Eaton E. Handoff improvement: we need to understand what we are trying to fix. Joint Commission Journal on Quality and Patient Safety. 2010;36(2):51.
Kachalia A, Gandhi TK, Puopolo AL, Yoon C, Thomas EJ, Griffey R, et al. Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. Annals of emergency medicine. 2007;49(2):196-205.
Harjola V, Huttunen K, Mattila J, Sandstrom T, Tolonen J. Evaluation of medical error risk in Helsinki university hospital emergency units. European Journal of Emergency Medicine. 2013;20(4):301-2.
Segall N, Bonifacio AS, Schroeder RA, Barbeito A, Rogers D, Thornlow DK, et al. Can we make postoperative patient handovers safer? A systematic review of the literature. Anesthesia & Analgesia. 2012;115(1):102-15.
Thomas MJ, Schultz TJ, Hannaford N, Runciman WB. Failures in transition: learning from incidents relating to clinical handover in acute care. The Journal for Healthcare Quality (JHQ). 2013;35(3):49-56.
Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. BMJ Quality & Safety. 2004;13(suppl 1):i85-i90.
Gogan JL, Baxter RJ, Boss SR, Chircu AM. Handoff processes, information quality and patient safety: A trans‐disciplinary literature review. Business Process Management Journal. 2013;19(1):70-94.
Fealy G, Donnelly S, Doyle G, Brenner M, Hughes M, Mylotte E, et al. Clinical handover practices among healthcare practitioners in acute care services: A qualitative study. Journal of clinical nursing. 2019;28(1-2):80-8.
Klim S, Kelly AM, Kerr D, Wood S, McCann T. Developing a framework for nursing handover in the emergency department: an individualised and systematic approach. Journal of clinical nursing. 2013;22(15-16):2233-43.
Pruitt CM, Liebelt EL. Enhancing patient safety in the pediatric emergency department: teams, communication, and lessons from crew resource management. Pediatric emergency care. 2010;26(12):942-8.
Doolan A, Shiel JC, Williams P, Hussain M, Corcoran G, Tan J, et al. P151 Assessing the use of the ISBAR3 handover framework in an irish paediatric hospital: a medical student perspective. BMJ Publishing Group Ltd; 2019.
Khalaf Z. Improving patient handover: a narrative review. African Journal of Paediatric Surgery. 2023;20(3):166-70.
SHALI M, JOOLAEE S, HOOSHMAND A, HAGHANI H. Committed nurse: This patient is wrong. 2016.
Randmaa M, Mårtensson G, Swenne CL, Engström M. SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: A prospective intervention study. BMJ open. 2014;4(1):e004268.
Starmer AJ, Spector ND, Srivastava R, West DC, Rosenbluth G, Allen AD, et al. Changes in medical errors after implementation of a handoff program. New England Journal of Medicine. 2014;371(19):1803-12.
Thompson JE, Collett LW, Langbart MJ, Purcell NJ, Boyd SM, Yuminaga Y, et al. Using the ISBAR handover tool in junior medical officer handover: a study in an Australian tertiary hospital. Postgraduate medical journal. 2011;87(1027):340-4.
Gross TK, Benjamin LS, Stone E, Shook JE, Chun TH, Conners GP, et al. Handoffs: transitions of care for children in the emergency department. Pediatrics. 2016;138(5).
Chaica V, Marques R, Pontífice-Sousa P, editors. ISBAR: a handover nursing strategy in emergency departments, scoping review. Healthcare; 2024: MDPI.
Yegane SAF, Shahrami A, Hatamabadi HR, Hosseini-Zijoud S-M. Clinical information transfer between EMS staff and Emergency Medicine Assistants during handover of trauma patients. Prehospital and disaster medicine. 2017;32(5):541-7.
Achrekar MS, Murthy V, Kanan S, Shetty R, Nair M, Khattry N. Introduction of situation, background, assessment, recommendation into nursing practice: a prospective study. Asia-Pacific journal of oncology nursing. 2016;3(1):45-50.
Müller M, Jürgens J, Redaèlli M, Klingberg K, Hautz WE, Stock S. Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review. BMJ open. 2018;8(8):e022202.
Pakcheshm B, Bagheri I, Kalani Z. The impact of using “ISBAR” standard checklist on nursing clinical handoff in coronary care units. Nursing Practice Today. 2020;7(4):266-74.
Dunsford J. Structured communication: improving patient safety with SBAR. Nursing for women's health. 2009;13(5):384-90.
Beigmoradi S, Pourshirvani A, Pazokian M, Nasiri M. Review nurses' skills in handover using SBAR tool in general ward. Evidence Based Care. 2019;9(3):63-8.
Pun J. Nurses’ perceptions of the ISBAR handover protocol and its relationship to the quality of handover: A case study of bilingual nurses. Frontiers in Psychology. 2023;14:1021110.
O'Hagan S, Manias E, Elder C, Pill J, Woodward‐Kron R, McNamara T, et al. What counts as effective communication in nursing? Evidence from nurse educators' and clinicians' feedback on nurse interactions with simulated patients. Journal of advanced nursing. 2014;70(6):1344-55.
Moi EB, Söderhamn U, Marthinsen GN, Flateland S. The ISBAR tool leads to conscious, structured communication by healthcare personnel. Sykepleien Forskning. 2019;14(74699):e-74699.
Fahajan Y, Albelbeisi A, Shnena YA, Emad OJ, Kweik DA, Kakemam E, et al. Effect of ISBAR Clinical handover application on Nurses’ perception of communication and attitudes toward patient safety at Emirates Maternity Hospital in Gaza Strip, Palestine. Ethiopian Journal of Health Sciences. 2023;33(5):769-80.
Safety WP, Organization WH. Patient safety curriculum guide: multi-professional edition. Patient safety curriculum guide: Multi-professional edition2011.
Marshall S, Harrison J, Flanagan B. The teaching of a structured tool improves the clarity and content of interprofessional clinical communication. BMJ Quality & Safety. 2009;18(2):137-40.
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