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Abstract: Background: The Joint Commission International Patient Safety Goal 2 states that effective communication between health care workers needs to improve. The aim of this study was to determine the effect of SBAR (situation, background, assessment, recommendation) on the incidence of serious adverse events (SAE's) in hospital wards. Method: In 16 hospital wards nurses were trained to use SBAR to communicate with physicians in cases of deteriorating patients. A pre (July 2010 and April 2011) and post (June 2011 and March 2012) intervention study was performed. Patient records were checked for SBAR items up to 48h before a SAE. A questionnaire was used to measure nurse–physician communication and collaboration. Results: During 37,239 admissions 207 SAE's occurred and were checked for SBAR items, 425 nurses were questioned. Post intervention all four SBAR elements were notated more frequently in patient records in case of a SAE (from 4% to 35%; p <0.001), total score on the questionnaire increased in nurses (from 58 (range 31–97) to 64 (range 25–97); p <0.001), the number of unplanned intensive care unit (ICU) admissions increased (from 13.1/1000 to 14.8/1000 admissions; relative risk ratio (RRR)=50%; 95% CI 30–64; p =0.001) and unexpected deaths decreased (from 0.99/1000 to 0.34/1000 admissions; RRR=−227%; 95% CI −793 to −20; NNT 1656; p <0.001). There was no difference in the number of cardiac arrest team calls. Conclusion: After introducing SBAR we found increased perception of effective communication and collaboration in nurses, an increase in unplanned ICU admissions and a decrease in unexpected deaths. [Copyright &y& Elsevier]