Professional Role · Topic 16 of 21

Interprofessional Collaboration & Communication

Professional role · team communication

Interprofessional Collaboration & Communication

Structure every critical message: SBAR to escalate, closed-loop for orders, I-PASS for handoffs, and the two-challenge rule when safety is ignored.

Key numbers

Call rapid response for acute deterioration or worryHR < 40 or > 130

I-PASS cut medical errors 23%errors ↓ 23%

Warning signs precede most inpatient arrests6–8 h of warning

01 · The ruleSBAR: Situation, Background, Assessment, Recommendation

SBAR structures any message that needs immediate attention and action: Situation (what is happening now), Background (clinical context), Assessment (what you think the problem is), Recommendation or Request (what you need, and when).

02 · DoClosed loop: request, repeat-back, confirm, complete

Closed-loop communication: the sender directs a request to a named person, the receiver repeats it back, the sender confirms or corrects, and the receiver reports completion — for every order, not only codes.

03 · The ruleI-PASS: structured handoff ending in synthesis

I-PASS structures handoffs: Illness severity, Patient summary, Action list (to-dos with owners and timelines), Situation awareness and contingency planning, and Synthesis by receiver, who restates the key points and asks questions.

The rules

Know these

Call-out: say critical findings to the whole teamA call-out announces critical information to all team members at once during an emergency ("heart rate now 78, back in sinus rhythm"), so everyone anticipates the next step and keeps a shared mental model.

Handoff content: code status, allergies, meds, contingenciesThe Joint Commission's minimum handoff content: sender contact, illness severity, patient summary and plan, to-do list, contingency plans, allergies, code status, medication list, and dated laboratory results and vital signs.

Brief before, huddle during, debrief afterA brief sets roles, goals and the plan before work starts; a huddle re-establishes situational awareness and adjusts the plan; a debrief afterward reviews what went well and what to improve.

What it is

Core idea

IPEC: four interprofessional competenciesThe 2023 IPEC core competencies for interprofessional collaborative practice are Values and Ethics, Roles and Responsibilities, Communication, and Teams and Teamwork.

Causes & risk factors

Why it happens

Warning signs precede most inpatient arrestsMost in-hospital cardiac arrests, unplanned ICU transfers and deaths are preceded by abnormal vital signs or mental status for an average of 6–8 hours — the window rapid response systems exist to use.

Diagnosis & monitoring

Work-up

Call rapid response for acute deterioration or worry must knowTypical triggers: acute HR < 40 or > 130, SBP < 90, RR < 8 or > 30, SpO₂ < 90% on oxygen, acute mental-status change, urine < 50 mL in 4 h — or staff worry.

I-PASS cut medical errors 23%In 9 hospitals (10,740 admissions), the I-PASS handoff program cut medical errors by 23% and preventable adverse events by 30%, without lengthening verbal handoffs (about 2.5 minutes per patient).

Management

Orders

Two-challenge rule, then chain of command must knowVoice an ignored safety concern assertively at least twice (CUS: "I am Concerned… Uncomfortable… this is a Safety issue"); the decision-maker must acknowledge it, and a persisting risk goes up the chain of command.

Hand off face-to-face, uninterrupted, with questionsHand off verbally — face-to-face or by real-time phone or video — somewhere free of interruptions, never by written or electronic note alone, and leave time for the receiver to ask questions.

Consult with a specific question and urgencyWhen requesting a consult, ask a specific question and state the urgency (emergent, urgent or routine); a common rule of thumb is that consults are seen within 24 hours, sooner when the question is time-critical.

Consultant: examine, then give five or fewer recommendationsAs a consultant, take your own history and exam, give brief, specific recommendations (five or fewer, with dose and duration) plus contingency plans, and discuss them verbally with the primary team.

Disagree in conversation, not in the chartWhen you disagree with another team's plan, discuss it directly with that clinician rather than writing the disagreement in the chart; if a safety concern persists, escalate through the chain of command.

DESC script for interpersonal conflictUse the DESC script to resolve conflict: Describe the specific behavior, Express your concern, Suggest alternatives and seek agreement, and state the Consequences for the patient or team.

SBAR or I-PASS?

Commonly confused

Job	Escalate a problem that needs action now
Typical moment	Calling a provider about a deteriorating patient
Starts with	Situation — what is happening now
Ends with	Recommendation or request — what you need

More detail

Reference

Show 4 reference facts

A rapid response system has an afferent limb (ward staff who recognize deterioration and activate the team), an efferent limb (the responding team), an administrative limb and a quality-improvement limb.

Rapid response team evidence is mixed: before–after studies show fewer arrests and deaths, but the cluster-randomized MERIT trial found no difference in arrests, unplanned ICU admissions or unexpected deaths.

Inadequate handoff communication contributes to sentinel events such as wrong-site surgery, treatment delays, falls and medication errors; communication failures played a part in about 30% of malpractice claims in a 2016 analysis.

TeamSTEPPS rests on four teachable skills — communication, leading teams, situation monitoring and mutual support; the I'M SAFE checklist (Illness, Medication, Stress, Alcohol and drugs, Fatigue, Eating and elimination) is each member's self-check.

Pearl

If it was not repeated back and confirmed, the loop is still open.

Sources · AHA Team Training — TeamSTEPPS Pocket Guide (adapted from the AHRQ/DoD TeamSTEPPS 3.0 curriculum), Feb 2024 · AHRQ TeamSTEPPS 3.0 — Tool: SBAR · The Joint Commission — Sentinel Event Alert 58: Inadequate hand-off communication (Sept 2017) · Starmer AJ et al. Changes in medical errors after implementation of a handoff program (I-PASS). N Engl J Med 2014;371:1803–1812 · Al-Qahtani S, Al-Dorzi HM. Rapid response systems in acute hospital care. Ann Thorac Med 2010;5:1–4 · Chang D, Gabriel E. 10 tips for hospitalists to achieve an effective medical consult. The Hospitalist (SHM), 2015 (updates Goldman's ten commandments) · Interprofessional Education Collaborative — IPEC Core Competencies Version 3 (2023), press release · Starter sheet built from the verified AGACNP fact map (facts reviewed 2026-10-15).