Clinical handoffs in low-resource settings: structural blind spots beyond situation, background, assessment, and recommendation

Medical and academic nursing have employed significant use of situation, background, assessment, and recommendation (SBAR). It is a standardized, effective, and recognized communication tool that promotes clear communication in a short time and is easily implemented in hospital-based procedures for information sharing among healthcare providers [1]. However, in low-resource settings (LRS), the handoff challenges arise not only from incorrect use of SBAR itself but from deeper systemic and structural limitations that hinder patient safety. These fundamentals include a lack of reliable help-seeking mechanisms, irregular or insufficient training, and the absence of standardized communication practices. Without these foundational systems, the efficacy of even well-equipped SBAR systems is significantly impaired. This manuscript aims to highlight that clinical handoff failures in low-resource healthcare situations are caused by intersecting structural, cultural, educational, and technological issues, rather than insufficient SBAR implementation alone. It advocates for context-sensitive adaptation and supportive mechanisms to ensure that structured communication tools like SBAR are genuinely effective.