What do you say first when you call a doctor?
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Understand
Six days into placement, student nurse Alex has to call a doctor about a patient who isn't right, and the first call falls apart. Then Alex's supervising nurse hands over a map: ISBAR (Identify, Situation, Background, Assessment, Recommendation), one of the structured handover tools used in Australian health services. Follow Alex through the five steps, hear the same call done again, then try the quick quiz.
Alex, Mrs Smith and all observations are fictional and for teaching only. Some services use ISOBAR (with an O for observations); same idea. Escalation charts and response times vary between states, countries and hospitals, so follow your local policy.
- Without a structure the listener has to guess: who, which patient, what's wrong, what you need.
- ISBAR answers those in the same order every time.
- Clear communication protects patients from harm (NSQHS Standard 6, Communicating for Safety).
Key takeaways
- Order: Identify, Situation, Background, Assessment, Recommendation, then read back.
- Identify yourself (name, role, where from), then the patient with at least three approved identifiers, such as full name, date of birth and MRN.
- Situation: one sentence, problem first. Recommendation: exactly what you need, by when.
- If you're worried, say so, and follow your local escalation policy.
In practice
- Before you call, have the chart and latest obs in front of you, and write the five letters down a page.
- End with what you need and by when, then read it back.
- Worried? Speak up and follow your local policy.
In one line
Use ISBAR: Identify, Situation, Background, Assessment, Recommendation, always in that order. Then read the plan back.
Check yourself
Alex says: "Hi, it's Alex, student nurse on Ward 5B." Which step is that, and what has to come next?
Show the answer
Identify. Next comes the patient, with at least three approved identifiers, such as full name, date of birth and medical record number.
Words to know
- ISBAR
- five steps for handing over
- ISOBAR
- ISBAR plus O for Observations
- Clinical handover
- passing a patient's care on
- Read-back
- the receiver repeats key points
Transcript
Read the narration
On a busy surgical ward, Alex is a student nurse, six days into placement. Mrs Smith in bed twelve had her hip replaced two days ago, and now her breathing is quicker and her skin feels hot.
Alex picks up the phone to call the doctor. If you were Alex, what would you say first? Hold that thought.
Alex's heart is racing, and out it comes. Hi, um, it's the nurse from the ward. So Mrs Smith, she had her hip done, and she's just a bit, I don't know, off?
Her obs are a bit funny. What do you want me to do? And the doctor replies. Sorry, which ward? Which patient?
And what are her obs? Pause here, and count the problems. There are five. The doctor doesn't know who's calling, where from, which patient, what's wrong, or what Alex needs.
Alex asks the doctor for one minute, and lowers the phone. Sam, the nurse supervising, says, you didn't do anything wrong. You just didn't have a map.
Here it is. Five steps, always in the same order. It's called ISBAR. ISBAR is one of the structured handover tools used in Australian health services.
Clear communication protects patients from harm. That's why the National Safety and Quality Health Service Standards include a whole standard on it. Standard six, Communicating for Safety.
Step one, I is for identify. Say who you are, your role, and where you're calling from. Then the patient, with at least three approved identifiers, like full name, date of birth, and medical record number.
Step two, S is for situation. Why are you calling? One sentence, problem first. Alex writes, I'm concerned she's deteriorating, and her obs are in the yellow zone.
Step three, B is for background. Only what's relevant: why she's in hospital, key history, and recent changes. Alex writes, seventy eight years old, day two after a partial hip replacement, with a history of type 2 diabetes.
Step four, A is for assessment. What have you found, and what do you think is going on? And it's okay to say, I'm worried. Step five, R is for recommendation, or request.
Say exactly what you need, and by when. Could you please review her within thirty minutes? Then read the plan back, so you both know it's right. Sam adds, follow your local escalation policy, like Between the Flags in New South Wales.
And if you're worried, speak up. Alex takes a breath, and dials again. Hi, it's Alex, student nurse on Ward 5B. I'm calling about Margaret Smith, born third of April 1947, MRN 1 2 3 4 5 6.
I'm concerned she's deteriorating, and her observations are in the yellow zone. She's seventy eight, day two after a partial hip replacement, with a history of type 2 diabetes.
Her resp rate is 24, sats 91 percent on room air, heart rate 112, blood pressure 104 on 68, and temperature 38.2. She has a new productive cough, and I think she may be developing a chest infection.
Could you please review her within thirty minutes? Thanks Alex, that's really clear. I'll be there in twenty minutes. Just to read back, you'll review her in twenty minutes.
Same patient, same nurse, under a minute. And twenty minutes later, the doctor walks in already knowing what to look for. Now it's your turn.
Pause if you need more time. Which part of ISBAR is this? Day two post op, with a history of type 2 diabetes. Three, two, one.
That's background. Next one. Could you please review her within thirty minutes? Three, two, one. That's recommendation.
Last one. Her sats have dropped to 91 percent. Three, two, one. That's assessment. So remember.
Identify. Situation. Background. Assessment. Recommendation.
Then read it back. Think back to what you would have said first. Would you say it differently now? Keep the five steps on a lanyard card, and practise them on placement.
Alex still gets nervous. But now Alex has a map. Comment below with the scariest phone call you've had to make on placement. Subscribe for next time: a full set of obs, and the red flags.
Alex and Mrs Smith are fictional. This is general education only, so always follow your local policies.
Sources
- ACSQHC - Communicating for Safety Standard (NSQHS Standard 6)
- Canberra Health Services - Clinical Handover procedure (ISBAR is the accepted handover method; I: three identifiers and introduce yourself; R: timeframes, read back so the receiver repeats key information)
- Victorian Department of Health - Clinical handover for older people in hospital (services use ISBAR or ISOBAR; read back of critical information)
- ACSQHC - Patient identification (at least three approved identifiers, including at clinical handover)
- ACSQHC - Specifications for a standard patient identification band (core identifiers: name, date of birth, medical record number)
- SESLHD - Between the Flags orientation 2025 (yellow zone: clinical review, JMO within 30 minutes on the local pathway; red zone: rapid response)
General education, not clinical advice. Check your local policy.