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MODULE 24: SPEAKING HOSPITAL: COMMUNICATION, CULTURE & POLITICS
Section 24.3: SBAR vs. SOAP: The Language of Clinical Reasoning
Moving beyond acronyms to master the two essential frameworks for verbal recommendations and written documentation.
SECTION 24.3
SBAR vs. SOAP: When to Use Which, with Micro-Examples
Choosing the right tool for the job: mastering the tactical briefing versus the strategic analysis.
24.3.1 The “Why”: From Freeform Conversation to High-Stakes Structure
In your retail practice, communication is often a fluid, freeform art. You adapt your style based on the person you’re speaking with—a detailed, empathetic explanation for an anxious patient; a quick, direct question for a busy nurse at a doctor’s office. You possess a high degree of communication intelligence that allows you to navigate these interactions successfully. However, the hospital environment, with its complexity, urgency, and multiplicity of providers, demands a more standardized approach. The risk of miscommunication is too high, and the consequences too severe, to rely on unstructured conversation for critical clinical issues.
This is why structured communication frameworks like SBAR and SOAP were developed. They are not meant to replace your clinical judgment or communication skills, but to enhance them. They are cognitive tools, forcing you to organize your thoughts into a logical, universally understood sequence before you ever open your mouth or type a note. They are the accepted “grammar” of professional healthcare communication.
- SBAR (Situation, Background, Assessment, Recommendation) is the language of urgency and action. It is a verbal briefing tool designed to convey a critical issue and a proposed solution in under 60 seconds.
- SOAP (Subjective, Objective, Assessment, Plan) is the language of documentation and analysis. It is a writing tool designed to create a permanent, comprehensive record of a patient’s condition and the clinician’s thought process.
Understanding the fundamental difference in their purpose—SBAR is for talking, SOAP is for writing—is the first and most important step. Using the wrong tool for the job is like trying to use a screwdriver to hammer a nail. You might eventually get the job done, but it will be messy, inefficient, and unprofessional. This section will make you a master craftsman, able to select and wield the perfect communication tool for any clinical scenario.
24.3.2 The Analogy: The 911 Call vs. The Full Police Report
A Deep Dive into the Analogy
Imagine you witness a traffic accident. You immediately call 911. The way you communicate with the dispatcher is a perfect real-world example of SBAR.
- (S)ituation: “There’s been a bad car accident.”
- (B)ackground: “It’s at the corner of Main and First Street. A blue sedan ran a red light and T-boned a white SUV.”
- (A)ssessment: “The driver of the SUV is unconscious and bleeding. The other driver looks dazed but is walking around.”
- (R)ecommendation: “You need to send an ambulance and police immediately.”
This entire communication takes 30 seconds. It is direct, fact-based, and ends with a clear, actionable request. You didn’t tell the dispatcher about the weather, what you were doing before the accident, or your opinion on the city’s traffic light timing. You gave them only the critical information needed to dispatch a response. **This is SBAR.**
Now, imagine an hour later, a police officer arrives to take your official witness statement for the accident report. This process is a perfect example of a SOAP note.
- (S)ubjective: The officer asks you to recount the events in your own words. “I was waiting to cross the street when I saw the blue car coming… it seemed to be going way too fast…” You describe what you saw, felt, and heard.
- (O)bjective: The officer then measures the skid marks, notes the final resting positions of the vehicles, checks the traffic light sequence, and records the make, model, and license plate numbers of the cars. These are the hard, verifiable facts.
- (A)ssessment: The officer, based on your subjective account and their objective findings, makes a professional judgment: “Based on the witness statement and the lack of skid marks from the sedan, my assessment is that the primary cause of the accident was failure to obey a traffic signal by the driver of the blue sedan, with speed as a contributing factor.”
- (P)lan: The officer concludes the report with the next steps: “Issue citation to driver of sedan. Both vehicles to be towed. Will obtain traffic camera footage for further investigation. Report to be submitted to records division.”
This report is detailed, methodical, and creates a permanent legal record. It analyzes the situation, it doesn’t just report it. **This is a SOAP note.** You use the 911 call (SBAR) when things are on fire, and the full police report (SOAP note) to document what happened for the official record.
24.3.3 Masterclass Part 1: SBAR — The Art of the 60-Second Clinical Briefing
SBAR is your primary tool for verbal communication, especially on rounds or when calling a provider about an urgent issue. Its rigid structure is its greatest strength. It forces you to distill a potentially complex situation into its essential components, ensuring your message is received and understood, even by a provider who is tired, stressed, and distracted. Your goal is to deliver a complete SBAR in a single, confident, uninterrupted statement.
The Pharmacist’s Guide to Building an SBAR
Here is how to construct each component of an SBAR from a pharmacy perspective. Before you ever pick up the phone, mentally (or physically, on your worksheet) fill in these four boxes.
| Component | Guiding Question | Pharmacist’s Focus | Example Phrase |
|---|---|---|---|
| (S) Situation | What is the immediate problem? | State your identity, the patient’s identity, and the specific, single issue you are calling about. This is the headline. | “Hi Dr. Smith, this is John the pharmacist. I’m calling about your patient Jane Doe in room 602. Her vancomycin trough level this morning was critically high.” |
| (B) Background | What is the relevant clinical context? | Provide 2-3 key pieces of information that are directly relevant to the situation. Do not give the patient’s entire life story. | “She’s a 78-year-old female who was admitted for pneumonia. We started vanc two days ago. Her creatinine today has increased from 0.9 to 1.8.” |
| (A) Assessment | What do you think is going on? | This is your professional clinical assessment of the situation. State the problem clearly and concisely. This is where you connect the dots between the Situation and Background. | “My assessment is that she is developing an acute kidney injury, likely secondary to the vancomycin, which is causing the drug to accumulate to a toxic level.” |
| (R) Recommendation | What do you want me to do? | Make a clear, specific, and actionable recommendation. If possible, make it a yes/no question to make it easy for the provider to agree. | “I recommend we hold the next two doses of vancomycin, get a repeat level in the morning, and consider changing to a different antibiotic like ceftaroline. Can I go ahead and enter that order for you?” |
SBAR Micro-Example Templates
The following are plug-and-play examples for common scenarios. Notice how they follow the exact structure outlined above.
Scenario 1: Critical Lab Value (Hyperkalemia)
Context: You are calling the intern about a patient with heart failure whose morning potassium level is dangerously high.
- S: “Hi Dr. Davis, this is [Your Name], the pharmacist. I’m calling about Mr. Jones in room 314. His potassium level this morning is critical at 6.8.”
- B: “He has a history of heart failure and stage 3 CKD. He is currently on lisinopril 20 mg and spironolactone 25 mg daily. He received his morning doses.”
- A: “My assessment is that this is life-threatening hyperkalemia, likely caused by the combination of his ACE inhibitor, spironolactone, and worsening renal function.”
- R: “I recommend we hold all future doses of lisinopril and spironolactone, and I need an order for an EKG STAT, plus emergency treatment with insulin, D50, and Kayexalate. Can you place those orders, or would you like me to request them for you?”
Scenario 2: Therapeutic Duplication on Admission
Context: You are performing a medication reconciliation on a newly admitted patient and discover a dangerous duplication.
- S: “Hi Dr. Lee, [Your Name] from pharmacy. For your new admission, Mrs. Chen in room 721, I’ve identified a critical therapeutic duplication on her medication list.”
- B: “The admission orders include apixaban 5 mg BID, which was continued from home. The ED also started a heparin infusion for a suspected PE before the home med list was verified.”
- A: “My assessment is that the patient is currently receiving dual anticoagulation with both a DOAC and a heparin drip, placing her at an extremely high risk for a major bleed.”
- R: “I recommend we immediately discontinue one of these agents. Since the heparin drip was started for the acute PE, I suggest we hold the home apixaban. Do you agree?”
24.3.4 Masterclass Part 2: The SOAP Note — Documenting Your Clinical Footprint
If SBAR is a verbal tool, the SOAP note is its written counterpart for formal documentation. It is your opportunity to create a permanent record of your clinical assessment and plan in the patient’s chart. A well-written pharmacy SOAP note is a mark of a sophisticated clinician. It demonstrates your ability to synthesize complex data, identify drug therapy problems, and formulate a logical plan. It is your clinical footprint, showing everyone who reads the chart the value that you, the pharmacist, brought to the patient’s care.
The Pharmacist’s Guide to Building a SOAP Note
Writing a pharmacy SOAP note is a systematic process of data gathering and analysis. Unlike an SBAR, which is brief, a SOAP note should be comprehensive yet concise.
| Component | Guiding Question | Pharmacist’s Focus |
|---|---|---|
| (S) Subjective | What is the patient (or caregiver) telling me? | Focus on medication-related issues. Document the patient’s reported symptoms (e.g., “patient states her pain is 8/10”), adherence issues (“patient reports missing doses of her blood pressure med 2-3 times per week”), allergies, or social history relevant to medication use (e.g., alcohol, tobacco use). |
| (O) Objective | What are the verifiable facts and data? | This is where you list hard data: vital signs (BP, HR, RR, Temp, O2 sat), pertinent lab results (renal function, liver function, electrolytes, drug levels), microbiology reports, diagnostic imaging results, and the current medication administration record (MAR). |
| (A) Assessment | What are the drug therapy problems? | This is the heart of your note and where you demonstrate your value. You synthesize the S and O to identify and prioritize the patient’s drug therapy problems (DTPs). Each problem should be stated clearly and linked to the evidence. For example: “1. Uncontrolled Hypertension: Patient’s home BP med is sub-therapeutic, and in-hospital BPs remain elevated despite current therapy. 2. Acute Kidney Injury: Cr has doubled since admission, likely related to initiation of vancomycin.” |
| (P) Plan | What are we going to do about each problem? | For each DTP identified in your assessment, you must propose a clear, specific, and actionable plan. A complete plan includes three parts for each problem: 1. Therapeutic Action: (e.g., “Increase lisinopril to 20 mg daily”). 2. Monitoring Parameters: (e.g., “Monitor BP daily”). 3. Patient Education: (e.g., “Educate patient on the importance of adherence.”). |
SOAP Note Micro-Example Template
The following is a common example of a pharmacy progress note written to address multiple drug therapy problems in a complex patient.
Scenario: Pharmacist Consult for Uncontrolled Type 2 Diabetes
Context: You have been consulted to provide recommendations for a 68-year-old male admitted for a COPD exacerbation who also has a long history of poorly controlled type 2 diabetes.
Pharmacy Progress Note – 10/07/2025 09:30
S: Patient states, “I’m supposed to take metformin, but I forget it a lot. I’m also supposed to check my blood sugar, but I don’t because I hate poking my finger.” Reports no symptoms of hyperglycemia like polyuria or polydipsia. Denies symptoms of hypoglycemia.
O:
Vitals: T 37.1, HR 88, BP 145/92, RR 18, O2 95% on 2L NC.
Labs: Na 138, K 4.1, Cl 100, CO2 25, BUN 22, Cr 1.2 (baseline 1.1). Glucose on admission 345 mg/dL. A1c on admission 9.8%.
Current Meds: Insulin Aspart sliding scale (BG >200), Metformin 1000 mg BID (held on admission), Lisinopril 10 mg daily, Atorvastatin 40 mg daily. Started on prednisone 40 mg daily and scheduled albuterol/ipratropium nebs for COPD.
A:
1. Uncontrolled Type 2 Diabetes Mellitus: Evidenced by A1c of 9.8%, admission glucose of 345, and patient-reported non-adherence to metformin. The current sliding scale insulin is an inadequate long-term strategy and will be exacerbated by the new high-dose steroid therapy (steroid-induced hyperglycemia). Patient requires a scheduled, basal-bolus insulin regimen for inpatient control and a simplified, more effective outpatient regimen.
2. Medication Non-adherence: Patient identifies forgetfulness and aversion to fingersticks as primary barriers. Regimen simplification is needed to improve long-term adherence.
P:
1. For Uncontrolled T2DM:
- – Recommend starting a basal-bolus insulin regimen: Insulin Glargine 20 units subcutaneously at bedtime and continue Insulin Aspart sliding scale for mealtime/correctional coverage.
- – Recommend consult for Diabetic Education to discuss diet and management.
- – Monitor fasting and pre-meal blood glucose levels QID. Monitor for signs of hypoglycemia.
- – For discharge, recommend changing from metformin BID to a once-weekly GLP-1 agonist (e.g., semaglutide) to improve adherence and provide superior glycemic control and cardiovascular benefits. Will discuss with primary team.
- – Will provide patient education on the importance of glycemic control and discuss simplified discharge regimen (e.g., once-weekly injection).
- – Will discuss the option of a continuous glucose monitor (CGM) at discharge to eliminate the need for fingersticks.
[Your Name], PharmD, BCPS
Clinical Pharmacist
24.3.5 When to Use Which: A Head-to-Head Comparison
Choosing between SBAR and SOAP is entirely context-dependent. It comes down to the urgency of the situation and the purpose of the communication. This table summarizes the key decision points.
| Factor | SBAR | SOAP |
|---|---|---|
| Primary Purpose | Verbal recommendation to drive an immediate action. | Written documentation to create a formal record of analysis. |
| Format | Verbal, concise, structured for speaking. | Written, detailed, structured for reading and legal record. |
| Core Focus | “Here is the problem, here is what we need to do NOW.” | “Here is a comprehensive analysis of the patient’s problems and my detailed plan to manage them.” |
| When to Use It |
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The Synergy of SBAR and SOAP
The most effective clinicians understand that SBAR and SOAP are not mutually exclusive; they are complementary tools that work in synergy. A common and highly effective workflow is to use SBAR to make a concise, actionable recommendation on rounds, and then to follow up by writing a comprehensive SOAP note in the chart. This achieves two critical goals:
- The SBAR ensures your recommendation is heard and acted upon in the moment.
- The SOAP note creates a permanent record of your analysis, justifies your recommendation with detailed evidence, and communicates your plan to the entire healthcare team (including those not present on rounds).
Think of it this way: SBAR is how you win the battle on rounds; SOAP is how you document the strategy that won the war for anyone to review later. Mastering both is the hallmark of a complete and effective clinical communicator.
