Structured conversations between clinicians or between pathologists and clinicians are a good idea – poor communication risks patient safety and contributes to adverse outcomes. The ISBAR framework enables clear, focused and information relevant clinical communications. Photo – blue ‘ISBAR’ species of chicken!
For Pathology labs, critical results (such as positive blood cultures) should be notified by phone to clinicians, an opportunity to provide therapeutic advice and to check that the patient is receiving the appropriate antibiotics. Once the culture result is known, it is usually possible to ‘direct’ the antibiotic therapy by chosing a narrow spectrum agent that matches the blood isolate(s). Use the ISBAR framework for your calls – it works and gains greater professional respect for the pathologists!
I – Introduction
“I am …… (name and role)” “I am calling from…….” “I am calling because……..” Confirm you are communicating to the intended person and ensure that the recipient is in a position to receive the communication. Identification of the patient must include the patient’s name, date of birth and medical record number.
S – Situation
“I have a patient (age and gender) who is stable yet I have concerns unstable with rapid/slow deterioration” “The presenting symptoms are…..”
B – Background
“This is the background of ….” (Give pertinent information which may include: Date of admission/ presenting symptoms on admission / medications/ test results/ status changes) This step also includes a brief synopsis of treatment to date and assessments / tests that are pending.
A – Assessment
On the basis of all of the above I believe the: The patient’s condition is …… And they are at risk of …… And in need of …..
R – Recommendation
Be clear about what you are requesting. e.g. “This patient needs transfer to / review …. Under the care of …. In the following time frame ….
[And remember D for documentation – all clinical communications and their outcome need to be documented somewhere .