Referrals from the emergency department (ED) to inpatient teams are routine but high-stakes interactions, yet little is known about how they are accomplished in practice. Prior work often treats referrals as information transfer and emphasises structural tensions between departments, paying limited attention to the interactional detail of referral calls. To address this gap, we draw on seventeen recorded referral calls collected during a year of ethnographic fieldwork in a metropolitan ED. We show how clinicians manage jurisdictional seams through fine-grained conversational moves, and identify navigation strategies: tentative problem framing, preference-sensitive questioning, implicit boundary negotiation, offering of assistance and follow-through, and balancing displays of competence and humility. We demonstrate how the patient's case is not treated as a fixed record but is reshaped in talk to align with different specialties, operating as a dynamic object. These insights extend accounts of boundary work by offering a micro-interactional view of how clinicians negotiate responsibility at jurisdictional seams, and contribute training implications that treat referral talk as interactional expertise, and design directions for improved referral tool technologies that surface seams, scaffold rather than script calls, and keep automation in service of clinical judgement.

Effective information support tools are challenging to design for fast-paced, information rich, and difficult to predict circumstances, particularly when information is fragmented and sources are dispersed. To explore, we conducted a field study on handover and the associated information work, which included 40 visits and 75 hours of observation and interviews with doctors in a metropolitan emergency department (ED). Beyond information exchange, we found that handovers highlight doctors' proactive approach by anticipating information needs, managing uncertainties arising from dynamic information, and developing patient care plans through multiple contingencies. Expanding on the idea of handover as a multifaceted process rather than a single event, we reinforce existing calls for greater flexibility emphasising that the ascertainment of pertinent information is an ongoing, adaptive process. This work demonstrates that deciding what constitutes relevant information is a priori indeterminate when designing information systems and support tools in environments such as EDs. We propose the preservation of specific ‘relativities’ of information—such as uncertainty, particularity, incompleteness, and temporality—in designing information support tools for dynamic, critical and multi-disciplinary work environments.

Head-worn displays (HWDs) offer their users high mobility, hands-free operation, and “see-what-I-see” features. In the prehospital environment, emergency medical services (EMS) staff could benefit from the unique characteristics of HWDs. We conducted a field study to analyze work practices of EMS staff and the potential of HWDs to support their activities. Based on our observations and the comments of EMS staff, we propose three use cases for HWDs in the prehospital environment. They are (1) enhanced communication between different care providers, (2) hands-free access to clinical monitoring and imaging, (3) and improved realism of training scenarios. We conclude with a set of design considerations and suggest that for the successful implementation of HWDs in EMS environments, researchers, designers, and clinical stakeholders should consider the harsh outdoor environment in which HWDs will be used, the extensive workload of staff, the complex collaboration performed, privacy requirements, and the high variability of work.

Quick service restaurants (QSRs) are high tempo work environments that require collaboration and communication between crew. In a number of respects, head-worn displays (HWDs) might seem a promising technology to support QSR crew, but on close inspection they raise challenging issues for design. We conducted fieldwork studies at two large QSRs to understand how work is organised, how existing systems are used, and how information is displayed to and communicated between crew. We observed the crew working both routinely and with improvisation, collaboratively and individually, physically and digitally. From our analysis of the field study, we identify tentative use cases for HWDs, but with these also design tensions-that is, opportunities coupled with challenges that appear difficult to circumvent even with modest design proposals. These tensions would require careful consideration if HWDs were to be deployed in in QSRs, given that HWDs are ubiquitous, potentially private, digital, mobile, and able to collect behavioural data.