Original Article

The impact of using “ISBAR” standard checklist on nursing clinical handoff in coronary care units


Background and Objective: Clinical handoff is the process of transmitting information, responsibility and accountability among the health care team members. Lack of standard protocols may result in the loss of essential information and also may lead to medical errors. The purpose of this study was to evaluate the impact of using a  standard checklists on clinical handoff in coronary care unit (CCU).
Method: This quasi-experimental study was performed based on pre- and post-test design at Afshar Hospital in Yazd. There were a total of 564 handoffs with the participation of 24 nurses in two coronary care units in 2017. Prior to the intervention, 282 clinical handoffs were recorded and implemented. Nurses were informed about the ISBAR standard checklist and were encouraged to use it for one week. Then, 282 clinical handoffs were again recorded and implemented. Frequency of providing information during clinical handoff was determined based on ISBAR checklist and the data were analyzed using descriptive statistics and chi-square test.
Results: Prior to the intervention, frequency of providing information during clinical handoff was reported as follows: patient identity (86.9%), current position (75.1%), clinical history (52.8%), system status review (59.9%), and recommendations (92.9%). The results showed that the indexes significantly increased (P <0.001) after the intervention in all these five domains: patient identity (100%), current situation (94%), clinical history (80.1%), system status review (92.2%) and recommendations (100%).
Conclusion: Transition of information based on standard checklists with a specific framework can increase the frequency of information provided during clinical handoff. Therefore, it is recommended to train nurses and nursing  students about standard handoff and related tools such as ISBAR in hospitals and universities.

1. Anderson J, Malone L, Shanahan K, Manning J. Nursing bedside clinical handover–an integrated review of issues and tools. Journal of Clinical Nursing. 2015;24(5-6):662-71.
2. Riesenberg LA, Leitzsch J, Little BW. Systematic review of handoff mnemonics literature. American Journal of Medical Quality. 2009;24(3):196-204.
3. Wakefield DS, Ragan R, Brandt J, Tregnago M. Making the transition to nursing bedside shift reports. The Joint Commission Journal on Quality and Patient Safety. 2012;38(6):243-AP1.
4. Chaboyer W, McMurray A, Johnson J, Hardy L, Wallis M, Chu FYS. Bedside handover: quality improvement strategy to “transform care at the bedside”. Journal of nursing care quality. 2009;24(2):136-42.
5. Etezadi T, Malekzadeh J, Mazlom SR, Tasseeri A. Nursing handover written guideline implementation: A way to improve safe performance of nurses in intensive care units. Evidence Based Care. 2012;2(2):7-18.
6. World Health Organization.Communication during patient hand-overs. Patient Safety Solutions. 2007;1(3):1-4.
7. Herawati VD, Nurmalia D, Hartiti T, Dwiantoro L. the effectiveness of coaching using SBAR (situation, background,assessment, recommendation) communication tool on nursing shift handovers. Belitung Nursing Journal. 2018;4(2):177-85.
8. Raeisi A, Rarani MA, Soltani F. Challenges of patient handover process in healthcare services: A systematic review. Journal of Education and Health Promotion.2019;8:173.
9. Australian Commission on Safety and Quality in Health Care. External Evaluation of the National Clinical Handover Initiative Pilot Program Final Report ACSHQC. 2011sydney.
10. Matic J, Davidson PM, Salamonson Y. bringing patient safety to the forefront through structured computerisation during clinical handover. Journal of clinical nursing. 2011;20(1‐2):184-9.
11. Li P, Stelfox HT, Ghali WA. A prospective observational study of physician handoff for intensive-care-unit-to-ward patient transfers. The American journal of medicine. 2011;124(9):860-7.
12. Vretare LL, Anderzén-Carlsson A. The critical care nurse’s perception of handover: A phenomenographic study. Intensive and Critical Care Nursing. 2020;7:102807.
13. 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.
14. Shahid S, Thomas S. Situation, Background, Assessment, Recommendation (SBAR) communication tool for handoff in health care–a narrative review. Safety in Health. 2018;4(1):7.
15. Uhm J-Y, Ko YJ, Kim S. Implementation of an SBAR communication program based on experiential learning theory in a pediatric nursing practicum: A quasi-experimental study. Nurse Education Today. 2019.
16. Barry M. Hand-off communication: Assuring the transfer of accurate patient information. American Nurse Today. 2014;9(1):30-1.
17. Joint Commission Center for Transforming Healthcare releases targeted solutions tool for hand-off communications. Joint Commission Perspectives. 2012;32(8): 1, 3.
18. 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.
19. Sarmila K, Raj M, Santosh A. Critical Care Nurses' Views on Handover in Chitwan, Nepal. Connect: The World of Critical Care Nursing. 2019;13:36-45.
20. Schmidt T, Kocher D, Mahendran P, Denecke K. Dynamic Pocket Card for Implementing ISBAR in Shift Handover Communication. Studies in health technology and informatics. 2019;267:224-9.
21. Superville JG. Standardizing Nurse-to-Nurse Patient Handoffs in a Correctional Healthcare Setting: A Quality Improvement Project to Improve End-of-Shift Nurse-to-Nurse Communication Using the SBAR I-5 Handoff Bundle: The University of North Carolina at Chapel Hill; 2017.
22. Coleman RL. Improving Nurse-to-nurse Handover Through Implementation of Standardized SBAR: Gardner-Webb University; 2018.
23. Pang WI. Promoting integrity of shift report by applying ISBAR principles among nursing students in clinical placement. InSHS Web of Conferences 2017; 37:01019. EDP Sciences.
24. 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.
25. Sundus.baqer.dawood, Ali RM, Bahaaldeen EF. Self-Evaluation of Nurses and Midwives Practices Using SBAR (Situation, Background, Assessment, Recommendation) Communication Tool on Maternal Health Documentation. Iraqi National Journal of Nursing Specialties 2018;31(2):57-67.
26. 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.
27. Spooner, A. J., Aitken, L. M., Corley, A., Fraser, J. F., & Chaboyer.Nursing team leader handover in the intensive care unit contains diverse and inconsistent content: An observational study. International journal of nursing studies, 2016, 61: 165-172.‏
28. Baghaei R, Khalkhali H, PourRashid S. the effect of using sbar model in nursing handoff on communication dimension of nursing care from the patientsview. The J Urmia Nurs Midwifery Fac. 2016;14(6):562-70.
29. Berman A, Snyder SJ, Frandsen G. Kozier & Erbs Fundamentals of Nursing concept,process and practice,global edition, tenth edition. edition T, editor: Julie Levin Alexander; 2018.
30. Shali M, Joolaee S, Hooshmand A, Haghani H. Committed Nurse: This Patient is wrong. Medical Ethics Journal. 2016;10(34):11-30.
31. 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.
IssueVol 7 No 4 (2020): Autumn QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v7i4.4036
nurses; coronary care unit; ISBAR, patient handoff

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Pakcheshm B, Bagheri I, Kalani Z. The impact of using “ISBAR” standard checklist on nursing clinical handoff in coronary care units. NPT. 7(4):266-274.