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Qual Saf Health Care. 2009 Apr;18(2):137-40. doi: 10.1136/qshc.2007.025247.

The teaching of a structured tool improves the clarity and content of interprofessional clinical communication.

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Southern Health Simulation and Skills Centre, Melbourne, Australia.



Suboptimal communication between health professionals has been recognised as a significant causative factor in incidents compromising patient safety. The use of a structured method of communication has been suggested to improve the quality of information exchange. The aim of this study was to determine if the teaching of a communication tool, ISBAR (Identify, Situation, Background, Assessment, Recommendation), a modification of SBAR (Situation, Background, Assessment, Recommendation), improved the content and clarity of a telephone referral in an immersive simulated clinical scenario conducted in real time.


Seventeen teams of final-year medical students were randomised into two groups. The intervention group participated in a 40 min education session about the ISBAR communication tool. A control group received no training. Each team of five students participated in a simulated clinical scenario using a patient simulator in a mocked-up clinical environment. During each scenario, one student made a telephone referral seeking assistance from a senior colleague. Audio data for the telephone referrals (n = 17 students) were captured during the scenario for both groups. During a blinded review of the data, communication was scored on both content and clarity.


Communication content was higher from a mean score of 10.2 to 17.4 items (p<0.001) with the intervention. Clarity of the delivery of information on a 5-point scale was also higher in the intervention group (rho = 0.903, p<0.001).


The teaching of a structured method of communication improved the communication during telephone referral in a simulated clinical setting. This research has implications for how healthcare professionals are taught to communicate with each other.

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