Effective communication during ICU referral is as important as the clinical decision to refer. Poorly structured referrals lead to misunderstandings, delays, and occasionally to the ICU team not appreciating the urgency of the situation. The SBAR framework — Situation, Background, Assessment, Recommendation — provides a structured approach that ensures all critical information is communicated efficiently.

S — Situation

Begin by identifying yourself and your role, then state clearly who you are calling about. Give the patient’s name, age, ward, and bed number. State the immediate clinical problem in plain terms: ‘I am calling about Mr Smith in Bay 3 on Ward 7 — he is 72 years old and has become acutely short of breath and hypotensive in the last hour.’ The ICU clinician should immediately understand why you are calling before you have given any further detail.

B — Background

Provide the relevant clinical context: the reason for the patient’s current admission, their significant past medical history, any relevant medications (particularly anticoagulants, immunosuppressants, or drugs that might affect resuscitation decisions), and their baseline functional status. A patient who was previously independent with no significant comorbidities has a very different clinical picture to one who was nursing home-dependent with multiple organ failure. The ICU team needs this context to make sensible clinical decisions.

A — Assessment

Give the current observations clearly and in full: respiratory rate, SpO2 and what oxygen it is achieved on, heart rate, blood pressure, temperature, GCS, and urine output if relevant. State the most recent blood gas results and any other pertinent investigations. Then give your clinical assessment: what do you think is happening, what have you done about it so far, and what is your level of concern? ‘My working diagnosis is hospital-acquired pneumonia with septic shock — I have given fluid resuscitation and started broad-spectrum antibiotics but he is not responding and I am very concerned about him.’

R — Recommendation

State clearly what you want from the ICU team. This might be advice about escalating treatment on the ward, urgent review at the bedside, or acceptance of the patient for ICU admission. Be direct: ‘I would like you to come and review him urgently, please.’ If you are not sure what level of input is needed, it is entirely reasonable to say so and ask the ICU clinician to help you decide.

SBAR Example — Referral for a Deteriorating Neurological PatientS: ‘Hi, this is Dr Jones, SHO on Ward 4. I’m calling about Mrs Campbell, a 58-year-old in Bed 6 — she was admitted yesterday with a seizure and her GCS has dropped from 14 to 9 in the last two hours despite lorazepam.’B: ‘She has a background of hypertension and epilepsy. She is on levetiracetam. CT head yesterday showed no acute pathology but she has not returned to baseline since the initial seizure.’A: ‘Current obs: RR 22, SpO2 94% on 4L O2, HR 108, BP 162/94, Temp 37.8, GCS 9 (E2V3M4). She is not protecting her airway reliably — she had a desaturation episode 15 minutes ago. NEWS2 is 8.’R: ‘I am very concerned she is going to lose her airway. I would like you to come and review her urgently — I think she may need intubation.’