Physician & Provider Escalation

SBAR Report Template: Nurse-to-Physician Communication

A structured escalation reporting format engineered specifically for calling attending physicians, on-call hospitalists, and mid-level providers during acute clinical deterioration and urgent order requests.

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Clinical Escalation Report Example

Urgent provider call

Clinical FrameworkSTAT / Emergent

Acute Coronary Syndrome / STEMI Escalation

Inpatient Post-Op Bedside Notification to On-Call Physician

Patient: David Ross (59yo M)

Bed/Room: Room 410

MRN: MRN-773194

Attending: Dr. Katherine Bell (On-Call Cardiologist/Hospitalist)

Situation

Immediate clinical concern & reason for calling right now

• Nurse Sarah calling from 4-West regarding Patient David Ross in Room 410. • Reason: Patient is experiencing acute substernal chest pressure (rated 7/10) radiating to the left jaw that started 15 minutes ago.

Background

Relevant clinical history, admitting diagnosis, medications & baseline

• 59-year-old male admitted yesterday for acute diverticulitis. • History: Hypertension and 20 pack-year smoking history. No prior documented coronary artery disease. • Current Meds: IV Cefoxitin 2g Q8H, IV Normal Saline at 100 mL/hr. • Allergies: Aspirin (causes mild stomach upset, no anaphylaxis). Code Status: Full Code.

Assessment

Current vital signs, objective physical findings & clinical interpretation

• Vitals: BP 162/94 (baseline 130/80), HR 98 regular, RR 22, SpO2 96% on room air, Temp 37.0°C. • Physical: Diaphoretic, pale, anxious. Lungs clear bilaterally. Heart sounds regular S1/S2 without murmurs. • STAT 12-lead ECG obtained 5 minutes ago reveals 2mm ST-segment elevation in leads V2-V4.

Recommendation / Request

Specific clinical action needed, timeframe & read-back confirmation

• I recommend you come evaluate this patient immediately. • I request orders for: 1. Activating the Cardiac Catheterization / STEMI Protocol. 2. Chewable Aspirin 324 mg PO STAT (confirming tolerability with allergy history). 3. Sublingual Nitroglycerin 0.4 mg SL Q5M x3 PRN chest pain (hold for SBP <100). 4. STAT Cardiac Troponin and CBC/BMP draw. • I will place patient on continuous cardiac monitor and establish a second large-bore IV.

CUS

Pairing SBAR with the TeamSTEPPS CUS Escalation Tool

When an urgent recommendation is met with hesitation, pushback, or delayed response, use standard TeamSTEPPS CUS phrases to establish unequivocal patient safety boundaries:

1. "I am Concerned..."

"I am concerned that this patient's systolic blood pressure is trending down to 88 mmHg despite the initial fluid bolus."

2. "I am Uncomfortable..."

"I am uncomfortable leaving this patient on the floor without an in-person bedside evaluation given their increasing oxygen requirements."

3. "This is a Safety Issue!"

"This is a patient safety issue. If you are unable to evaluate at bedside within 10 minutes, I will need to initiate the Rapid Response Team."

Checklist Before Dialing the Healthcare Provider

Verify that you have all essential patient parameters in front of you before making the telephone call:

✓Fresh Vitals (last 15 min): Blood pressure, heart rate, respiratory rate, SpO2 with oxygen device, and temperature.

✓Chart Open: Active Medication Administration Record (MAR), allergy list, and code status immediately visible.

✓Diagnostic Results: Recent lab trends (CBC, BMP, Lactate, Troponin) and diagnostic imaging reports on screen.

✓Clear Requested Action: Formulate an explicit recommendation (e.g. order set, fluid bolus, bedside arrival time) before dialing.

How to Give SBAR Report→SBAR-R Read-Back Protocol→Nursing SBAR Form→

Clinical Communication Notice

Telephone Order Best Practice: Always perform a complete read-back of all verbal and telephone orders in accordance with Joint Commission NPSG 02.03.01. Pronounce drug names distinctly and spell out numerical units.