Use SBAR (or ISBAR) when a nurse calls a provider about a change in condition. Use an I-PASS-style structure for nurse-to-nurse shift report, because it ends with the receiving nurse summarizing back what they heard. In a nursing home, most units benefit from both, used for different moments.
Ask ten nurses which handoff format their facility uses and you'll hear SBAR, ISBAR, I-PASS, a homegrown sheet, or "we just talk." The Joint Commission is clear that structure helps, and just as clear that a mnemonic alone doesn't fix hand-offs without training and a culture that protects the time.1 Still, picking the right structure for the right moment is a good place to start.
How do SBAR, ISBAR and I-PASS compare?
| Format | Stands for | Best for | Strength | Watch out for |
|---|---|---|---|---|
| SBAR | Situation, Background, Assessment, Recommendation | A nurse calling a physician, NP or PA about one resident | Fast and familiar; ends with a clear ask | Not built for handing over a whole assignment |
| ISBAR | Identify, then SBAR | Phone calls and staff who don't know each other, such as agency or float nurses | Adds who is calling and about whom | Same limits as SBAR for full shift report |
| I-PASS | Illness severity, Patient summary, Action list, Situation awareness and contingency plans, Synthesis by receiver | Nurse-to-nurse shift report across several residents | Strongest published evidence; the receiver confirms what they heard | Takes training to do well; developed in hospitals |
The mnemonics themselves come straight from The Joint Commission's hand-off alert, which lists them as examples facilities can adapt.1
What does the evidence say about I-PASS?
I-PASS has the strongest data. In a study across nine medical centers and 10,740 patient admissions, the I-PASS program was associated with a 23% drop in medical errors and a 30% drop in preventable adverse events.2 The study was done in hospital residency programs, not nursing homes, so the numbers don't transfer directly. The principle does: structure plus a receiver who repeats back what they heard catches errors.
Which format should a nursing home use?
Most skilled nursing units need two structures, not one:
- SBAR for change in condition. Many nursing homes already use an SBAR form for calls to the provider. The INTERACT program's SBAR Communication Form walks the nurse through checking vitals and the record before calling, then situation, background, assessment and request.3 Keep it.
- An I-PASS-style structure for shift report. Shift change is a different job: many residents, short time, and a receiving nurse who may not know them. Lead with who is sickest, give the summary, the to-do list and what to do if things change, then have the incoming nurse say back the key points.
- ISBAR when the receiver is new. With agency and float staff, start every call and report with who you are and which resident you mean. It sounds obvious. It's the step that gets skipped.
Where does AI fit in a structured handoff?
Every one of these formats asks the nurse to gather facts before speaking: background, recent changes, pending actions. That gathering is the slow part, and it's the part AI can do. ChartRail reads the chart and referral documents ahead of the shift and fills in the background and what changed for each resident, each line cited to its source page. The nurse keeps the parts that need judgment: the assessment, the recommendation and the conversation. For what a full handoff should contain, see why shift handoff is the riskiest 15 minutes in skilled nursing.
Frequently asked questions
What is the difference between SBAR and I-PASS?
SBAR (Situation, Background, Assessment, Recommendation) structures a call about one patient, usually from a nurse to a provider. I-PASS (Illness severity, Patient summary, Action list, Situation awareness, Synthesis by receiver) structures a handoff of responsibility, such as shift report, and ends with the receiver summarizing back.
Is I-PASS evidence-based?
Yes. A multicenter study published in the New England Journal of Medicine found a 23% reduction in medical errors and a 30% reduction in preventable adverse events after I-PASS was implemented in hospital residency programs.
Do nursing homes use SBAR?
Many do, especially for change-in-condition calls to physicians, nurse practitioners and physician assistants. The INTERACT program includes an SBAR communication form designed for nursing homes.
What is ISBAR?
ISBAR adds Identify to SBAR: the caller first states who they are, their role and which patient they are calling about. It is useful for phone calls and when staff don't know each other.
Book a 30-minute demo with our founders, or ask about our design partner program.
Book a demo- The Joint Commission, Sentinel Event Alert 58: Inadequate hand-off communication (2017)
- Starmer AJ, et al. Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 2014
- INTERACT SBAR Communication Form and Progress Note for nursing homes (Indiana Department of Health copy)