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CHI '26 · Honorable mention · full-paper review · confidence medium-high

Out of Emergency: How Doctors Navigate Jurisdictional Seams in Emergency Care Referrals

Aloha Hufana Ambe , Isaac Salisbury , Tobias Grundgeiger , Daniel Bodnar , Sean Rothwell , Nathan Brown , Ben Matthews

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This is a solid qualitative CHI paper with a clear empirical contribution: it moves referral work from a generic information-transfer story to a situated interactional account of jurisdiction, responsibility, and case-shaping. The scope is intentionally narrow, but the claims are well matched to the evidence.

Axes Lens

Rare contribution shape, typical evidence profile. The point here is not a score. It is to show what kind of claim the paper makes, and whether the evidence pattern is unusual or baseline in this 268 -review set.

Review Summary

This paper’s strength is that it takes a familiar clinical coordination problem and shows why the interactional details matter. Rather than treating referral calls as a simple handoff of facts, it demonstrates that clinicians actively manage jurisdictional seams through talk: they frame problems tentatively, ask in preference-sensitive ways, negotiate boundaries implicitly, offer assistance, and balance competence with humility. That is a meaningful CHI/CSCW contribution because it reframes referral as situated work, not just communication overhead. The novelty is not a new system or algorithm; it is a careful empirical account of a practice that prior work had flattened into structural tension or information transfer. The evidence base is appropriately modest and qualitative: seventeen recorded calls from one metropolitan ED, analyzed from the ED physician side. That supports descriptive and interactional claims, but not prevalence, generality across settings, or patient-outcome effects. The paper is strongest when it stays close to the data and uses the corpus to build a micro-interactional account of how responsibility is negotiated in practice. Its design implications also seem sensible: surface seams, scaffold rather than script calls, and keep automation subordinate to clinical judgment. The main limitation is scope, not credibility. Because the sample is single-site and one-sided, the paper cannot tell us how often these strategies occur, how receiving teams interpret them, or whether they improve downstream care. Still, within those bounds, the contribution is clear and well aligned with the evidence.

What Changed

Canon before

Prior work often treats referrals as information transfer and emphasizes structural tensions between departments, with limited attention to interactional detail of referral calls.

Departure from common sense

The paper argues that ED referral calls are not merely routine information transfer; clinicians actively negotiate responsibility and jurisdiction in the interaction, and the patient case is reshaped in talk rather than simply passed along as a fixed record.

Actual novelty

Its main contribution is a micro-interactional account of jurisdictional seam management in referral calls, identifying a repertoire of conversational strategies such as tentative problem framing, preference-sensitive questioning, implicit boundary negotiation, offering assistance and follow-through, and balancing competence with humility.

Evidence

The paper analyzes seventeen recorded referral calls from a year of ethnographic fieldwork in a metropolitan ED, using conversation-analytic attention to the ED physician side of the interaction. The evidence supports a focused qualitative account of how referral work is accomplished in practice and where responsibility is negotiated, but it does not support frequency estimates or outcome claims.

Limits

Method limits

The study is based on a small, selective corpus of 17 recorded calls from one metropolitan ED and analyzes only the ED physician’s side of each conversation, so it cannot establish prevalence, causal effects, or full bilateral interactional dynamics.

Deployment limits

The findings are most directly applicable to similar emergency-to-inpatient referral contexts and to training or tool design that aims to support, rather than script, clinician judgment in live calls.

Boundary conditions

The account is bounded by a single-site ethnographic sample, recorded referral calls, and the specific jurisdictional seam between ED and inpatient teams; it may not transfer unchanged to other specialties, institutions, or referral modalities.

Manual check: none

Position in field

This sits in the CHI boundary-work / CSCW tradition as a fine-grained interactional study of clinical coordination, extending prior structural accounts by showing how responsibility is negotiated moment by moment in talk.

Abstract

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.