Healthcare Professionals’ Implementation of SBAR to Reduce Safety Incidents in Non-Acute Clinical Settings: A Systematic Review

Abstract

Background:

Communication failures cause most serious medical errors, with non-acute care environments being particularly vulnerable. While situation-background-assessment-recommendation (SBAR) is proven in acute settings, its safety impact in non-acute clinical settings remains unclear.

Methods:

This systematic review followed PRISMA 2020 guidelines and a pre-registered protocol (PROSPERO CRD420251139601). We searched PubMed, CINAHL, Cochrane Library, and Ichushi-Web through September 2025. Studies evaluating SBAR interventions for healthcare professionals in non-acute settings were eligible. Two reviewers independently performed selection, extraction, and risk-of-bias assessment (RoB 2, ROBINS-I). Evidence certainty was evaluated using GRADE.

Results:

Eleven studies (1 RCT, 10 quasi-experimental) were included. SBAR implementation improved structured communication adherence (43.6%-91.0% in long-term care; 4.0%-79.0% in psychiatry). One hemodialysis study reported reduced incidents (36-9 events), but an RCT found no reduction in adverse events despite improved INR control. Staff satisfaction generally improved (87.5% nurses reporting utility). Evidence for patient-centered outcomes was very limited. GRADE certainty was very low. Successful implementation required leadership support, clinical champions, context-specific adaptation, and iterative PDSA cycles; barriers included time constraints and hierarchical culture.

Conclusions:

SBAR is feasible for standardizing communication in non-acute settings; however, robust evidence of clinical effectiveness is lacking. Successful adoption requires active, context-sensitive strategies guided by implementation science frameworks.