Communication Questionnaire:

Pre – Simulation

1. Do you feel comfortable communicating changes in the patients’ status to the physician?

Yes or No

2. Do you feel that you know what information should be provided to the physician when calling to report patient concerns/test results?

Yes or No

3. Are you familiar with the SBAR?

Yes or No

4. If you are familiar with the SBAR, do you feel that it is effective for providing report?

Yes or No Why?

5. Should the SBAR be completed before or after calling the physician?

OPTIONAL:
Feedback regarding communication with the physician