How is an ED SBAR different from an inpatient SBAR?

ED SBARs focus on the active workup, pending results, and disposition planning rather than ongoing management. The patient may have been in the department for only a few hours, so Background emphasizes the presenting complaint and initial workup rather than hospital course. Critically, the Recommendation section must address disposition — is the patient being admitted, discharged, or still in diagnostic limbo?

Should I include pending lab results in an ED SBAR handoff?

Absolutely — pending results are often the most important part of an ED handoff. State exactly what is pending, when it was drawn, when you expect it back, and what the result will change. For example: 'Second troponin drawn at 2100, expect result by 2130. If elevated, cardiology already notified and standing by for cath lab activation.' This saves the incoming nurse from having to reconstruct the diagnostic plan.

How do I handle mid-workup ED handoffs?

Be explicit about where you are in the diagnostic algorithm. State what has been completed, what is pending, and what the decision tree looks like. Use the Recommendation section to lay out the if/then logic: 'If troponin positive, activate cath lab protocol. If negative, third troponin at 0130 per chest pain pathway. If all three negative plus stress test low-risk, discharge with cardiology follow-up.' The incoming nurse needs the complete decision map.

Emergency Department SBAR Example: ED Handoff Report

Emergency Department handoffs are uniquely challenging because you are often handing off a patient mid-workup. Unlike inpatient units where the diagnosis is established and the plan is in motion, ED patients may still be in diagnostic limbo — and the incoming nurse needs to know exactly where in the workup you are, what is pending, and what each result means for the patient's disposition.

The example below covers the classic ED scenario: a chest pain workup with serial troponins pending. Notice how the SBAR framework captures not just the current clinical picture but the entire decision tree that the incoming nurse will need to navigate.

SBAR Example: Chest Pain Workup — Troponins Pending

Situation

Mr. Warren, bay 11, 58-year-old male, presented at 1745 via EMS with acute onset substernal chest pressure radiating to his jaw while mowing the lawn. Pain was 8/10 on arrival, now 2/10 after nitroglycerin x3 and morphine 4mg IV. He is currently on continuous cardiac telemetry and waiting on his second troponin. ED attending Dr. Kim is managing, cardiology has been given a heads-up but not formally consulted yet. Patient is anxious but cooperative. Wife is in the family waiting area.

Background

PMH: HTN (poorly controlled per PCP notes — often forgets medications), hyperlipidemia, Type 2 DM (A1c 8.1 per last labs 3 months ago), former smoker (quit 5 years ago, 40-pack-year history), family hx significant for father with MI at age 52. Home meds: metoprolol 50mg BID, lisinopril 20mg daily, atorvastatin 40mg daily, metformin 1000mg BID — patient admits he hasn't taken meds in about a week due to a pharmacy issue. Allergies: NKDA. Access: 18g L AC, 20g R hand (both patent). Given on arrival: ASA 325mg PO, NTG 0.4mg SL x3 (3 minutes apart), morphine 2mg IV x2, heparin 5000 units IV bolus per chest pain protocol. EKG #1 (1800): ST depression 1mm in V4-V6 and lead II, no ST elevation. EKG #2 (1930): unchanged from first. First troponin (drawn 1810): 0.08 ng/mL (elevated — normal <0.04). CBC: WBC 9.2, H/H 14.1/42. BMP: Cr 1.1, K 4.2, glucose 218. Coags: INR 1.0, PTT 28. CXR: cardiomegaly, no pulmonary edema or infiltrate. BNP 340 (mildly elevated).

Assessment

VS current: BP 148/92 (was 172/98 on arrival), HR 82 NSR on tele (was 104 on arrival), RR 18, T 98.4, SpO2 98% RA. Pain 2/10, pressure-like, no radiation currently. Tele showing NSR with occasional PVCs — no runs of VT, no ST changes on monitor. Lungs clear bilaterally. Peripheral pulses 2+ all extremities. No JVD, no peripheral edema. Diaphoresis resolved. Patient calmer after morphine but remains worried — asking repeatedly if he is having a heart attack. Second troponin drawn at 2015 (3-hour mark) — result expected by 2045. Heparin drip started at 18 units/kg/hr per weight- based protocol at 2000, no bolus repeat. PTT due 6 hours after drip started (0200). BG 218 — sliding scale insulin coverage given per protocol (4 units regular insulin).

Recommendation

Second troponin result expected by 2045 — this is the critical decision point. If troponin is rising (above 0.08 or significantly higher), Dr. Kim plans to formally consult cardiology for possible cath lab tonight. Cardiology fellow Dr. Abrams is aware and expecting the call if needed. If troponin is stable or trending down, third troponin at 2345 (6-hour mark) and plan for admission to telemetry floor for observation and cardiology consult in the morning. Serial EKGs: next EKG due at 2100 — repeat immediately if patient reports any recurrence of chest pain. Call attending if any new ST changes on tele monitor. Heparin drip: titrate per weight-based protocol, PTT at 0200. Keep NPO in case of cath lab — patient is aware and has been told no food or drink. Wife in family waiting area, bay 11 number is on the tracking board — Dr. Kim plans to update her after second troponin results. If patient is admitted, bed request already placed for telemetry unit — bed control said approximately 2-3 hour wait. Admission orders are drafted but not signed pending troponin.

Why Decision Trees Matter in ED Handoffs

The Recommendation section in this example reads like a decision tree, and that is intentional. ED nursing is fundamentally about moving patients through a diagnostic algorithm toward disposition — and the incoming nurse needs to know exactly where in that algorithm the patient sits, what the branch points are, and who to call at each branch.

Also notice the first troponin was elevated (0.08 vs normal of less than 0.04). This is flagged in the Background but its clinical significance is explored in the Recommendation: the second troponin will determine whether this is an acute NSTEMI requiring urgent cath or a more stable presentation appropriate for observation. That if/then logic is exactly what the incoming nurse needs.

Speak Your ED Handoff, Get Instant SBAR

ED shifts are chaotic. Between the patient in bay 11 and the three new arrivals in triage, writing structured handoffs is a luxury you do not have. ShiftSBAR lets you speak your patient update in 30 seconds and generates a structured SBAR — pending results, disposition plans, and escalation criteria all organized automatically.