Lingua CoPilot MedicalFaculty Pack
Most SBAR examples online are filled-in forms. A form cannot interrupt you, tell you to call back in an hour, or ask about a result in front of the patient. This pack gives nursing faculty the parts of an SBAR practice session that are hard to write and easy to get wrong: the receiver’s script with scripted pressure moves, a session method that runs in a classroom with two chairs and a phone, a debrief order, and two observation checklists. It does not contain ready-made cases: each of the three scenario frames has a case card and a policy card that you complete from your institution’s own teaching cases and policies, so that every clinical detail a learner sees has been through your own review.
Why the clinical content is yours
Escalation chains, early-warning scores and their thresholds, verbal-order rules and critical-result windows differ between countries, hospitals and curricula, and a scenario is only safe to teach when its clinical details match the protocols your learners will actually work under. This pack therefore contains no clinical values, thresholds, orders or management answers: the communication method comes from the public sources listed at the end, and the clinical content comes from your institution’s own reviewed cases and policies.
Nurse and doctor role names in the frames are fictional; patients are bracketed slots. About a 29-minute read in full; each frame reads on its own.
The Method
Students can recite the four letters in their first week. Observed handoffs (handovers) still fail, in predictable ways. The eleven points below are the communication behaviors the frames and the checklists are built around. Each names what learners get wrong, what it sounds like, what to teach instead, and where the practice comes from.
Have the chart, current medicines, allergies, IV fluids, the latest vital signs, the relevant result with the previous one for comparison, and code status at hand; know whether you have seen and assessed the patient yourself; decide the ask before you dial.
Sounds like: “Let me check and call you back.” Instead: The preparation done, and the ask decided, before dialling.
IHI SBAR Tool, “Prior to calling the physician”.
Your name, role and unit; the patient by name and the second identifier your hospital uses; then “this is an urgent call”, or “this is an update, no action needed”, or “I need advice”, and how worried you are.
Sounds like: The story of the shift, with the reason for the call arriving after thirty words of history. Instead: Who, which patient, and how urgent, before any history.
IHI SBAR Tool: “what is it, when it happened or started, and how severe”; The Joint Commission Goal 1, at least two patient identifiers.
A single value has no meaning without the baseline, and the receiver does not have it. If your hospital uses a score with a response chart (NEWS2 is one example), naming the score, its change and the threshold it has crossed tells the receiver which response the chart requires.
Sounds like: One number, no baseline. Instead: The earlier value, the current value, and the score.
Royal College of Physicians, NEWS2, as an example of a response chart; your local chart governs.
The test for each item: would this change what the receiver decides? Include the admitting diagnosis and date, the comorbidities and medicines that cause or mask the problem, allergies, the last relevant result with its previous value, and code status where relevant. Leave out what does not pass, however true.
Sounds like: Everything in the chart, in the order it was written. Instead: Four or five items, each of which changes the decision.
IHI SBAR Tool; SBAR-LA.
Students are taught not to diagnose, so they stop at the numbers. The assessment is your judgment stated as a concern or a working problem. The IHI’s own worked example has the nurse say “I think he’s got an active bleed and we can’t rule out an MI.”
Sounds like: The numbers, then silence. Instead: The numbers with the trend, then “I’m worried this is...”
IHI SBAR Tool, Example 1; SBAR-LA.
“I need you to come and see him now. Do you want anything sent while you are on the way? If he gets worse before you arrive, I will [the next step your escalation policy sets].”
Sounds like: “Just wanted to let you know.” Instead: An ask the receiver has to answer, with a time attached.
AHRQ TeamSTEPPS; IHI SBAR Tool, “Patient needs to be seen now”.
When the reply is “watch and call me in an hour”, restate the evidence, say why the delay is not safe (the trend, the threshold on your chart), and ask again. If refused twice, say what you will do next, using the chain your policy sets. TeamSTEPPS gives this a structure: CUS (“I am Concerned, I am Uncomfortable, this is a Safety issue”) and the two-challenge rule.
Sounds like: “Okay, I’ll call you in an hour.” Instead: The evidence again, the reason, the next step.
AHRQ TeamSTEPPS: CUS, Two-Challenge Rule.
Repeat each order, the plan, and when the doctor will arrive; ask them to confirm; then record the change in condition, the notification, who received it, the orders, and that read-back was done, in the form your verbal-order and critical-result policies require. Time-specific elements are where read-back errors hide: “now” and “in the morning” sound alike on a busy ward.
Sounds like: “Okay, doctor.” Instead: Every order repeated, times included.
IHI SBAR Tool, step 4: “Document the change in the patient’s condition and physician notification”; your hospital’s verbal-order policy.
Report it within the time and to the person your hospital’s policy defines, with read-back, and document it. “The patient feels fine” is not a reason to wait.
Sounds like: “It was a bit high, I’ll mention it on rounds.” Instead: The critical-result call, now.
The Joint Commission Goal 1: critical results reported on a timely basis, with the organization defining by whom, to whom and within what time; your hospital’s critical-result policy.
Almost every SBAR example online is an escalation call. A handoff needs continuity, not a request. Then the receiver summarizes it back.
Sounds like: “The report is pending, physio is coming.” Instead: Who chases what, by when, and what happens if the evening check is abnormal.
I-PASS: action list, situation awareness and contingency planning, synthesis by receiver.
Ask the patient who should be present. In front of the patient: plain language, the patient invited to add or correct, and the safety checks your bedside handoff policy specifies, done together. Away from the bedside: results the treating doctor has not yet discussed, sensitive history, and family matters; new sensitive information is not disclosed in front of family without the patient’s permission.
Sounds like: A new finding announced at the bedside. Instead: Two parts, and the patient’s say on who hears the first.
AHRQ, Nurse Bedside Shift Report Implementation Handbook.
The Session
Before the session: complete the cards. Each frame has a case card (the clinical content, from your own reviewed material) and shares one policy card (your local rules). Complete them before the round; the receiver’s script and the model-call template read from them. Nothing on this page replaces them.
One per institution, reused across frames.
One lead communicator per round. Each round has exactly one learner in the lead role: the caller in frames 1 and 3, the outgoing nurse in frame 2. A round is 30 minutes: ten minutes with the case card (the lead prepares; the receiver reads the script and pressure moves; the observer reads the checklist), five minutes for the call or handoff, ten minutes for the debrief, and a five-minute second attempt by the same lead. Plan one round for every learner who needs the lead role.
Frames 1 and 3 run in threes: lead, receiver, observer. Rotating the lead through all three members takes three rounds, 90 minutes. Two rounds fit in an hour.
Frame 2 needs five people (outgoing nurse, oncoming nurse, patient, family member, observer), or four if the observer reads the family member’s one line. Only the outgoing nurse is the lead, so giving every member the lead would take five rounds, 150 minutes. In practice, run frame 2 once or twice in a session (30 or 60 minutes), give the lead to the learners who most need bedside-handoff practice, and let faculty or repeating students hold the patient and family roles.
Debrief in a fixed order. The lead completes the self-check first (each frame type has its own version, below), before anyone else speaks. Then the observer goes through the checklist, reading out what they heard, not what they thought. Then the receiver answers the receiver’s test for that frame type. Reflection before feedback is deliberate: learners who hear the observer’s verdict first anchor on it and stop noticing their own performance. Two questions work in every frame: which three facts did you leave out on purpose, and what exactly did you ask for, or plan, and by when?
Play the pressure moves fairly. Each receiver script has three moves. They test specific behaviors; they are not there to win. Use them in order, skip any the lead has already handled, and concede when the lead has done what the move tests. Tell the group before the first round that the moves are scripted.
No specialist simulation equipment needed. A phone call is two chairs back to back. A bedside handoff is a chair for the patient. Where your institution permits recording, a recorded attempt makes the self-check more accurate: obtain the learner’s consent, follow your institution’s recording policy, and use an approved device and storage location.
The second attempt matters more than the first. The lead goes again immediately, with the same card, and the observer notes what changed.
The Scenario Frames
Frame 1
Tests: points 1 to 8 above: nurse-to-doctor escalation under time pressure and hierarchy, with a dismissive first reply and orders to read back.
A ward nurse, late in a shift, finds that a patient’s observations have changed for the worse since the previous set, with at least one other finding that points the same way. The on-call doctor is busy elsewhere. The nurse must recognize that this is a call-now situation, prepare, call, hold the concern when the doctor proposes a delay, obtain a review, read back the orders, and document.
You are busy elsewhere. Play busy, not hostile. Use the moves in order; skip a move the lead has already covered.
Move 1, early in the call, cutting across the lead
“I’m in the middle of something. Just give me the vitals.”
Tests: Does the lead give the numbers with the trend and still state the concern and the ask, or drop to a readout?
Move 2, when the lead has finished
“Sounds like [the benign explanation on the case card]. [A holding measure] and call me back in an hour.”
Tests: Does the lead accept the hour? A strong lead restates the evidence from the case card, names the threshold on the policy card and the response it requires, and asks again. Refuse once more. When the lead states the next step from the policy card (“I’m not comfortable waiting; I’m going to [next step]”), concede.
Move 3, once the lead has held their position
Give the orders from the case card, in one breath, ending with your arrival time.
Tests: Read-back of every item, with attention to the time-specific elements, and whether the lead confirms the contingency before the call ends.
The model call’s S below is the strong version.
“Hello doctor, [ward] here. [Patient], the [procedure] patient from yesterday, had [distractor] this evening, and [distractor], and now says [symptom] and the BP is a bit low...”
“[Doctor], this is [name], staff nurse, [ward]. I’m calling about [patient], [second identifier], bed [ ], [age], [admission and day]. This is an urgent call: I think [the concern]. [Score] has gone from [baseline] at [time] to [current] now, which is [the threshold on your chart].”
Identity, patient with two identifiers, call type, concern and trend in four sentences.
“[Two or three history and medicine items that change the decision]. [Last relevant result] was [value] at [time]. At [time] the observations were [baseline].”
Only what changes the decision, and the baseline that makes the current numbers meaningful. The distractors are absent.
“Now [current observations]. [The other findings]. [Symptoms]. I’m worried this is [the concern].”
Findings with the trend, then the concern in words.
“I need you to come and review [him/her] now; [score] is at [the threshold] and rising. I’ve increased observations to [frequency per policy]. Do you want anything sent while you’re on the way? If [the contingency trigger] before you get here, I’ll [the next step on the policy card].”
Action, time, a question that forces a decision, and the contingency from the policy card.
“[Time]. Change in condition: [summary]. Reported by phone to [doctor, role]. Orders received and read back: [each order, with its timing]. [Doctor] to review at [time]. [Nurse, role].”
Frame 2
Tests: points 4, 8, 10 and 11 above: nurse-to-nurse continuity, selection, contingency planning, the patient’s say on who is present, and the two-part bedside handoff with a result the patient has not yet been told about.
At the end of a shift, the outgoing nurse hands over at the bedside to the oncoming nurse. The patient is improving. A family member is present and has questions of their own. One item in the notes is a new finding that the treating doctor has not yet discussed with the patient. The outgoing nurse must confirm who the patient wants present, hand over what matters in plain language, do the safety checks with the oncoming nurse, give a plan with owners and times and contingencies, defer the undisclosed finding honestly, and hand it over away from the bedside.
The moves test the two-part handoff and the plan. Use them in order; skip any the lead has already covered.
The oncoming nurse, at the bedside, after the background
“What did the consultant say about [the undisclosed finding]?”
Tests: Does the outgoing nurse defer the question to the away-from-bedside part without lying or alarming the patient?
The patient, immediately after
“Is my [test] okay?”
Tests: An honest deferral: the doctors will go through the reports with the patient on rounds, and the nurse commits to making sure that happens. Not “everything’s fine”, not “the doctor will explain”, not silence.
The family member, while the plan is being handed over
“When is [she/he] going home? Nobody has told us anything.”
Tests: Acknowledgment, a specific commitment (who will speak to them and when), and a return to the handoff.
The oncoming nurse, at the end
Summarize the shift plan back in three lines.
Tests: Whether the handoff produced a plan the receiver can repeat.
At the bedside
“[Patient], this is [oncoming nurse], who will be looking after you today. You said earlier you’d like [family member] to stay while we hand over; is that still all right? [Oncoming nurse], this is [patient], [age], [second identifier], day [ ] with [diagnosis], and [trajectory]. [Admission in one sentence]. [Comorbidity and its medicine and timing]; [the earlier event, why, what was done, and how things are since]. [What is being weaned, from what to what]. [Current status in one sentence]. [Risk and its check]. [Lines and devices with dates]. Today: [pending items with owners and times]. [Contingency one]. [Contingency two]. [Patient], is there anything you’d add, or anything you want [oncoming nurse] to know?”
Away from the bedside
“Two things I didn’t say in front of [her/him]. [The undisclosed finding], which [the treating doctor] will discuss on rounds; [she/he] hasn’t been told, so if asked, it’s for the doctors this morning. And [family member] wants a private word about [topic]; I said you would find them after rounds.”
Frame 3
Tests: points 2, 5, 7, 8 and 9 above: reporting a critical value to a doctor who dismisses it, refuting with evidence, and reading back time-specific orders.
The laboratory phones a result flagged as critical on a patient who says they feel fine and whose observations are normal. The on-call doctor’s first reply is that the sample is probably spurious and should be repeated in the morning; the second is that the patient is asymptomatic and can wait for rounds. The nurse must report the result as a critical-result call, refute the dismissal with the evidence on the case card, state the concern the observations do not show, obtain the case’s required actions now, read them back, and document per the critical-result policy.
Play the dismissals as written; they are the frame’s reason to exist. Concede once the lead has held their position.
Move 1, straight after the result
“It’s probably [the spurious cause]. Just repeat it in the morning.”
Tests: Does the lead refute with evidence (the laboratory has excluded the spurious cause; the value has changed from the previous one; the condition on the case card makes it credible) and restate the concern?
Move 2, after the refutation
“[The patient]’s asymptomatic. I’ll see [him/her] on rounds.”
Tests: Does the lead say, professionally, that feeling well does not make the value safe, and ask for the case’s required actions now? If refused again, does the lead name the next step from the policy card?
Move 3, once the lead has held their position
Give the orders from the case card, in one breath, including their time-specific elements, and say when you will review.
Tests: Read-back of every item, with attention to the time-specific elements, where sound-alike confusions (“now” versus “in the morning”) hide. Then documentation.
The model call’s S below is the strong version.
“Doctor, sorry to disturb you. [Patient]’s [test] has come back a bit high, [value]. [He/she] seems fine though. Just wanted to let you know.”
“[Doctor], this is [name], staff nurse, [ward]. I’m calling with a critical lab result on [patient], [second identifier], bed [ ], [age], [admission]. [Test] on the [time] sample is [value], flagged critical; the lab has confirmed [the spurious cause is excluded].”
Call type first, two identifiers, and the most likely dismissal pre-empted in the first sentence.
“[The condition, and the medicines if applicable, with their timing]. The previous [test] was [value] on [day].”
Only what changes the decision.
“[He/she] feels well. [Current observations], [score if used]. But the [test] has gone from [previous] to [value] in [interval], and I’m concerned about [the risk on the case card].”
The normal observations stated, and then the concern the observations do not show.
“I’d like [the immediate actions the case requires], and I need [the decision the case requires]. Can you come and review [him/her] this evening?”
Action, timing, and a question that forces a decision.
“[Time]. Critical result: [test] [value] ([sample time]; lab confirms [ ]). Reported by phone to [doctor, role]. Orders received and read back: [each order, with its timing]. [Doctor]’s review time: [ ]. [Nurse, role].”
The Debrief Tools
Two checklists, because a shift handoff does not naturally contain a call type, a request for action, or orders to read back; and matching escalation and handoff versions of the receiver’s test and the learner self-check. All are formative tools for practice rounds and simulation; none is a validated instrument, and none is intended for assessing real handoffs. Items are marked Done or Not done, with what the observer heard written beside each: the developers of the SBAR-LA rubric found that raters could not reliably separate partial from complete performance, and that a present-or-absent judgment was more reliable.
Escalation call
Did I know how urgent this was from the opening? What did I still need to ask before I could decide, and should the caller have covered it?
Shift handoff
Could I take over this patient’s shift from the handoff alone? What did I still need to ask, and should the outgoing nurse have covered it? Do I know what to watch, and what to do if it changes?
Completed before anyone gives feedback.
Escalation call
Did I say why I was calling before any history? Did I say how worried I was, in words? Which three facts did I choose to leave out? Did I state my concern, or only the numbers? What exactly did I ask for, and by when? What did the receiver say back, and did I repeat it? If the receiver had said “wait and watch”, what would I have said? What will I change on the next attempt?
Shift handoff
Did I state today’s priorities before the history? Which three facts did I choose to leave out? Did every pending item leave with an owner and a time? What did I decide not to say at the bedside, and why? What would the patient say they learned? Did the receiver’s summary match my plan? What will I change on the next attempt?
Between Sessions
A faculty-run round gives each learner one or two attempts in a session, and the receiver’s behavior depends on who is playing the part. Between sessions, Lingua CoPilot Medical’s Structured Clinical Handoffs station lets nurses practice the same behaviors against AI physicians, nurses and care coordinators who interrupt, rush, and ask clarifying questions, across shift handoff, routine update, critical result, medication review, discharge and transfer contexts, with structured feedback and evidence that educators can review. The station’s cases are its own; this pack does not reproduce them.
Questions
Because the right clinical details depend on where you teach. Escalation chains, early-warning scores and their thresholds, verbal-order and critical-result rules, and medication practice differ between countries, hospitals and curricula, and a published case that hard-codes one set of values would be wrong, or unsafe to copy, somewhere else. The frames give you the communication method; the case card carries clinical content from your own reviewed material, matched to your local protocols and standards.
From your institution’s case bank, your own reviewed teaching scenarios, or a textbook case adapted to your ward. The case card lists what each frame needs and why (a baseline and a current set, a result with its previous value, distractors, a contingency).
No specialist simulation equipment is needed. A phone call is two chairs back to back; a bedside handoff is a chair for the patient. If your institution permits recording, a recorded attempt makes the self-check more accurate: obtain the learner’s consent, follow your institution’s recording policy, and use an approved device and storage location.
The added letters are commonly read as Identify and Read-back, but institutions define the variants differently, so check your curriculum’s definitions. Whichever label your curriculum uses, the frames include identification at the start and read-back at the end.
Not as published. They are formative tools for practice rounds and simulation, and they have not been validated. Formal assessment needs a validated instrument suited to your setting. SBAR-LA is one such instrument; it was developed and tested mainly with simulated performances, and its authors note that further clinical-setting evidence would strengthen it.
Yes. The checklists, receiver tests, self-checks and card templates are published under a Creative Commons Attribution licence: copy, adapt and share them with attribution to Lingua CoPilot Medical. The frames on this page may be used and adapted for teaching on the same terms.
Version 1.0 · August 2026. The checklists, receiver tests, self-checks and card templates in the downloadable pack are licensed under Creative Commons Attribution 4.0 International (CC BY 4.0).