S: Situation (What is happening right now?)

• Identify yourself, your unit, and the patient (name, room, admitting provider)
• State the immediate concern in one sentence

"I am calling about ___ in room ___. The problem is ___. It started ___ and it is (getting worse / stable / improving)."

B, Background (What led up to this?)

• Admitting diagnosis and date of admission
• Relevant medical history, allergies, and code status
• Recent treatments, medications, labs, or procedures

A, Assessment (What do you think is going on?)

• Most recent vital signs (and how they've changed)
• Focused assessment findings related to the concern
• Your clinical impression, it's OK to say "I'm not sure what the problem is, but the patient is deteriorating"

R, Recommendation (What do you need?)

• Say what you think is needed: "I request that you ___" (assess the patient, give an order, transfer)
• Clarify: "If no improvement, when should I call back?"
• Read back any new orders to confirm

Worked Example

S	"This is Maria, RN on 4 West, calling about Mr. Lee in 412, Dr. Osei's patient. He has new shortness of breath that started 30 minutes ago and is getting worse."
B	"He's post-op day 1 from a total hip replacement. History of heart failure. He's a full code, allergic to sulfa. He received IV fluids overnight."
A	"Respirations 28, SpO₂ 89% on room air, up from 96% an hour ago. Heart rate 112, BP 148/90. Crackles in both bases. I'm concerned about fluid overload."
R	"I've raised the head of the bed and started oxygen at 2 L. I'd like you to assess him, and would you consider a chest X-ray and diuretic? If he worsens before you arrive, I'll call the rapid response team."