Situation Background Assessment Recommendation (SBAR): Undergraduate Perspectives

Situation Background Assessment and Recommendation (SBAR): Undergraduate Perspectives C Morgan, L Adams, J Murray, R Dunlop, IK Walsh. Ian K Walsh, Centre for Medical Education, Queen’s University Belfast, Mulhouse Building, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6DP Background and Purpose: Structured communication tools are used to improve team communication quality.1,2 The Situation Background Assessment and Recommendation (SBAR) tool is widely adopted within patient safety.3 SBAR effectiveness is reportedly equivocal, suggesting use is not sustained beyond initial training.4-6 Understanding perspectives of those using SBAR may further improve clinical communication. We investigated senior medical undergraduate perspectives on SBAR, particularly when communicating with senior colleagues. Methodology: Mixed methods data collection was used. A previously piloted questionnaire with 12 five point Lickert scale questions and 3 open questions was given to all final year medical students. A subgroup also participated in 10 focus groups, deploying strictly structured audio-recorded questions. Selection was by convenience sampling, data gathered by open text questions and comments transcribed verbatim. In-vivo coding (iterative, towards data saturation) preceded thematic analysis. Results: 233 of 255 students (91%) completed the survey. 1. There were clearly contradictory viewpoints on SBAR usage. A recurrent theme was a desire for formal feedback and a relative lack of practice/experience with SBAR. 2. Students reported SBAR as having variable interpretation between individuals; limiting use as a shared mental model. 3. Brief training sessions are insufficient to embed the tool. 4. Most students reported SBAR helping effective communication, especially by providing structure in stressful situations. 5. Only 18.5% of students felt an alternative resource might be needed. Sub analysis of the themes highlighted: A. Lack of clarity regarding what information to include and information placement within the acronym, B. Senior colleague negative response to SBAR C. Lack of conciseness with the tool. Discussion and Conclusions: Despite a wide range of contradictory interpretation of SBAR utility, most students wish to retain the resource. More practice opportunities/feedback may enhance user confidence and understanding. References: (1) Leonard M, Graham S, Bonacum D. The human factor: the critical importance of effective teamwork and communication in providing safe care. Quality & Safety in Health Care 2004 Oct;13(Suppl 1):85-90. (2) d'Agincourt-Canning LG, Kissoon N, Singal M, Pitfield AF. Culture, communication and safety: lessons from the airline industry. Indian J Pediatr 2011 Jun;78(6):703-708. (3) Dunsford J. Structured communication: improving patient safety with SBAR. Nurs Womens Health 2009 Oct;13(5):384-390. (4) Compton J, Copeland K, Flanders S, Cassity C, Spetman M, Xiao Y, et al. Implementing SBAR across a large multihospital health system. Jt Comm J Qual Patient Saf 2012 Jun;38(6):261-268. (5) Ludikhuize J, de Jonge E, Goossens A. Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation 2011 Nov;82(11):1428-1433. (6) Cunningham NJ, Weiland TJ, van Dijk J, Paddle P, Shilkofski N, Cunningham NY. Telephone referrals by junior doctors: a randomised controlled trial assessing the impact of SBAR in a simulated setting. Postgrad Med J 2012 Nov;88(1045):619-626.

A Microbial Link to Weathering of Postglacial Rocks and Sediments, Mount Viso Area, Western Alps, Demonstrated through Analysis of a Soil/Paleosol Bio/Chronosequence

Understanding the mechanism associated with rates of weathering and evolution of rocks→sediment→soil→paleosol in alpine environments raises questions related to the impact of microbial mediation versus various diverse abiotic chemical/physical processes, even including the overall effect of cosmic impact/airburst during the early stage of weathering in Late Glacial (LG) deposits. This study is of a chronosequence of soils/paleosols, with an age range that spans the post–Little Ice Age (post-LIA; <150 yr), the Little Ice Age (LIA; AD 1500–1850), the middle Neoglacial (∼3 ka)–Younger Dryas (YD; <12.8 ka), and the LG (<15 ka). The goal is to elicit trends in weathering, soil morphogenesis, and related eubacterial population changes over the past 13–15 k.yr. The older LG/YD paleosols in the sequence represent soil morphogenesis that started during the closing stage of Pleistocene glaciation. These are compared with undated soils of midto late Neoglacial age, the youngest of LIA and post-LIA age. All profiles formed in a uniform parentmaterial ofmetabasalt composition and in moraine, rockfall, protalus, and alluvial fan deposits. Elsewhere in Europe,North America, and Asia, the cosmic impact/airburst event at 12.8 ka often produced a distinctive, carbon-rich “black mat” layer that shows evidence of high-temperature melting. At this alpine site, older profiles of similar LG age contain scorched and melted surface sediments that are otherwise similar in composition to the youngest/thinnest profiles developing in the catchment today. Moreover, microbial analysis of the sediments offers new insight into the genesis of these sediments: the C and Cu (u = unweathered) horizons in LG profiles present at 12.8 ka (now Ah/Bw) show bacterial population structures that differ markedly from recent alluvial/protalus sample bacterial populations. We propose here that these differences are, in part, a direct consequence of the age/cosmic impact/weathering processes that have occurred in the chronosequence. Of the several questions that emerge from these sequences, perhaps the most important involve the interaction of biotic-mineral factors, which need to be understood if we are to generally fully appreciate the role played by microbes in rock weathering.