SBAR telephone referral — severe hyperkalaemia
PLAB 2 & PRES 3 · communication · hard · 8 minutes
Candidate brief
You are an FY2 doctor/SHO on an acute medical ward. You have assessed Mr Patrick O’Connor, 76, who has acute kidney injury, a potassium level of 6.8 mmol/L and ECG changes. Telephone the on-call medical registrar, provide a structured urgent handover and agree on the immediate management and escalation plan. You are not required to speak with the patient during this station.
What examiners look for
A safe referral begins with the urgent problem, not a long chronological history. Use SBAR or ISBAR3: Identify: yourself, the receiver, the patient and location. Situation: state what is happening and why the call is urgent. Background: give only information needed to understand the current risk. Assessment: state the observations, key results, examination and your clinical impression. Recommendation: say clearly what you need, how urgently and what should happen next. Confirm the agreed plan using read-back. Establish who is attending, the expected timeframe, what you should do meanwhile and when to escalate again. Severe hyperkalaemia with ECG changes requires immediate treatment. Do not wait for a senior doctor to arrive before starting the local emergency protocol. IV calcium protects the heart but does not reduce serum potassium. Insulin–glucose shifts potassium into cells, while nebulised salbutamol may be used as an adjunct. Monitor ECG, potassium and blood glucose closely. Review potassium-raising and nephrotoxic medicines, urine output, volume status and the cause of acute kidney injury. Seek urgent renal or critical-care support when hyperkalaemia is refractory or accompanied by severe AKI, oliguria, acidosis, fluid overload or possible need for dialysis.
Guideline references
- https://assets.hse.ie/media/documents/ISBAR-Communication-Tool.pdf
- https://www.hse.ie/eng/about/our-health-service/healthcare-communication/module-4/deteriorating-patient-handover-demonstration-debrief-sheet.pdf
- https://www.england.nhs.uk/patient-safety/managing-acute-physical-deterioration-through-the-prevention-identification-escalation-response-pier-approach/
- https://www.gmc-uk.org/professional-standards/the-professional-standards/good-medical-practice/domain-3-colleagues-culture-and-safety
- https://www.nice.org.uk/guidance/ng148
- https://www.ukkidney.org/health-professionals/guidelines/treatment-acute-hyperkalaemia-adults-0
- https://www.resus.org.uk/professional-library/2025-resuscitation-guidelines/special-circumstances-guidelines
- https://www2.healthservice.hse.ie/organisation/nqpsd/pst/safety-alerts/Potential-risk-of-underdosing-with-calcium-gluconate-in-severe-hyperkalaemia/
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