Hospice ISBAR: Clearer Calls, Faster Comfort
A guide to hospice communication in crisis: preserving clarity, steadying teams, and speeding comfort when time is short
A Good Call Can Prevent a Bad Death
Calls carry emotion, not just data. Time is short, and clarity is essential.
“ISBAR was born from nuclear urgency. In hospice, we face human urgency.”
Brian H. Black, D.O.
Introduction
ISBAR grew from SBAR, a safety tool developed by the U.S. Navy for clear communication between nuclear submarines. It later entered health care and now structures handoffs across clinical settings, including palliative care (Burgess et al., 2020; Pinto et al., 2025).
Hospice ISBAR isn’t a phone script. It’s a discipline that converts anxiety into clarity, steadies teams, and protects dignity when minutes matter.
In the pause between uncertainty and decision, your next words decide whether the night steadies or spins. In hospice, clarity isn’t optional for care. It is the care.
Before You Dial: The 30-Second ISBAR Checklist
Before you call
Confirm goals and code status.
Identify the primary concern.
Have meds, allergies, and vitals ready.
Steady your voice; tone sets temperature.
Repeat orders verbatim before ending.
Perfection isn’t the goal. Precision with compassion is. (42 C.F.R. § 418.56(e) requires a system of communication and integration among hospice providers; ISBAR can support that coordination.)
Worst First: Identify the Urgency
Lead with what threatens comfort now.
Consider these two versions of the same hospice call:
Story-first call (inefficient):
“I’m seeing John today. He is a sweet guy, but more restless lately and less talkative. Triage called to get a visit scheduled because family is worried... I drove there today and he has definitely declined... His O₂ is 84%.... What do you want to do?”
Worst-first ISBAR (idealized):
“This is Ashley, the after-hours nurse. John Smith is 94, somnolent, and ashen. He is on service for COPD and CHF. RR 34, O₂ 84% on 3 L/min. PPS dropped to 20%. No edema. The current PRN morphine is not controlling distress for the full ordered interval. I am concerned he is transitioning. Please review the comfort-medication plan now; I will notify the chaplain.”
The first drifts. The second directs. A clear ISBAR can shorten the path to symptom-control decisions and help the team respond while the family gathers.
Great calls:
State the threat.
Give the facts that change action.
Offer a next step.
ISBAR does all three. Fast.
ISBAR Evidence at a Glance
Benefits:
In one small hospice before-and-after study, missed information fell from 51% to 2%, incomplete information from 26% to 4%, and medication errors from 7% to 3% after SBAR implementation (Pinto et al., 2025).
In the same study, documentation of psychological needs rose from 29% to 39% and spiritual needs from 17% to 39% (Pinto et al., 2025).
A systematic review found moderate evidence that SBAR may improve patient safety, especially in telephone communication (Müller et al., 2018).
ISBAR can structure verbal or written handoffs when the team shares the framework and practices it (Burgess et al., 2020).
Limits & Fixes:
“Used with judgment, ISBAR becomes fluency, not just formula. Used rigidly, it misses the moment.”
Brian H. Black, D.O.
Beyond the Phone: Why It Matters
Use ISBAR for nurse-to-provider calls, team hand-offs, IDG updates, and debriefs.
“Name the worst first. Say what you believe. Offer the next step.”
Brian H. Black, D.O.
Introduction
Inadequate hand-off communication contributes to serious adverse events, including delays in treatment, falls, and medication errors (The Joint Commission, 2017). In hospice, that means families may miss moments they can never reclaim.
Clarity builds trust across the power gap. It lets the clinician see the scene.
Across the IDG
RN: Lead with symptom + time course; confirm PRN window.
SW/Chaplain: Add emotional or spiritual insight in A.
Aide: Report new functional loss or barrier.
NP/Physician: Turn the ask into a clear, time-bound order.
All: Read back key orders before hanging up.
Each clear call can shorten the path to comfort and support the coordination required by 42 C.F.R. § 418.56(e). Used well, ISBAR is teamwork in real time.
- ISBAR structures urgent hospice calls.
- Leading with the worst-first concern puts urgency first and keeps the call focused on comfort.
- Stating clinical judgment builds trust and guides decisions.
- Practice a 30-second ISBAR at the next team huddle.
- Open the next IDG with a two-minute ISBAR drill.
“What is the worst-first concern, and what comfort-focused response do you need now?”
- Agency for Healthcare Research and Quality. (2023). Tool: Check-Back (or Repeat-Back). TeamSTEPPS 3.0. https://www.ahrq.gov/teamstepps-program/curriculum/communication/tools/checkback.html
- Burgess, A., van Diggele, C., Roberts, C., & Mellis, C. (2020). Teaching clinical handover with ISBAR. BMC Medical Education, 20(Suppl 2), 459. https://doi.org/10.1186/s12909-020-02285-0
- Electronic Code of Federal Regulations. (2026). 42 C.F.R. § 418.56: Condition of participation: Interdisciplinary group, care planning, and coordination of services. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-418/subpart-D/section-418.56
- MacDougall-Davis, S. R., Kettley, L., & Cook, T. M. (2016). The “go-between” study: A simulation study comparing the “Traffic Lights” and “SBAR” tools as a means of communication between anaesthetic staff. Anaesthesia, 71(7), 764–772. https://doi.org/10.1111/anae.13464
- Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open, 8(8), e022202. https://doi.org/10.1136/bmjopen-2018-022202
- Pinto, F., Roberto, P., Ferrario, L., Marotta, L., Montani, D., Auletta, G., Zoppini, L., & Foglia, E. (2025). Using “Situation–Background–Assessment–Recommendation” method in palliative care to enhance handover quality and nursing practice: A mix method study. Journal of Clinical Nursing, 34(1), 117–127. https://doi.org/10.1111/jocn.17537
- Pun, J. (2023). Nurses’ perceptions of the ISBAR handover protocol and its relationship to the quality of handover: A case study of bilingual nurses. Frontiers in Psychology, 14, 1021110. https://doi.org/10.3389/fpsyg.2023.1021110
- The Joint Commission. (2017). Sentinel Event Alert 58: Inadequate hand-off communication. https://www.jointcommission.org/en-us/knowledge-library/newsletters/sentinel-event-alert/issue-58
Brian H. Black, D.O., FAAFP, HMDC, is a hospice physician-educator, family physician, and editor of Hospice Synopsis. His work focuses on making hospice care clearer, more clinically useful, and more human. Through Hospice Synopsis, Dr. Black translates clinical evidence, bedside experience, and the complexities of end-of-life care into practical guidance for clinicians, patients, families, and communities.