// Clinical Practice

Four Letters From a Submarine: SBAR and the Discipline of Saying the Important Thing First

SBAR is four letters that most clinicians can recite and rather fewer can actually use under pressure. This post traces it properly: what the framework does to a sentence, the worked clinical call, where it really came from — US Navy nuclear submarines by way of a retired Navy captain at Kaiser Permanente in 2002, with the historical caveat that the popular account overstates — its spread into aeromedical evacuation and the wider high-reliability world, and then the part most SBAR teaching skips: what the trial and systematic-review evidence actually shows, including a randomised controlled trial in which SBAR did not significantly improve the content of a referral, and a 2021 review finding that fidelity collapses the moment you leave the classroom. Ends with the variants worth adopting and the four places SBAR stops working.