Analysis of work system components in interprofessional communication to determine shock etiology

In critical care settings, lack of agreement among clinicians on shock etiology is associated with higher mortality. Effective interprofessional communication may facilitate agreement on etiology and reduce mortality. This study sought to understand the interaction of work system components (people, environments, tools, tasks) in interprofessional communication to determine shock etiology. We interviewed 28 physicians, advanced practice providers, nurses, and pharmacists at three United States hospitals using a Critical Incident Technique. Analysis was guided by the Systems Engineering Initiative for Patient Safety model. The principal finding was that clinicians worked across fragmented physical, socio-organizational, and digital environments to balance the urgency to treat shock with intermediate steps to reduce diagnostic uncertainty. The results suggest that future research should acknowledge the benefits of productive disagreement among clinicians and develop supports that promote synchronous communication by bridging physical and socio-organizational fragmentation, compiling and systematizing relevant clinical information, and generating shared awareness among clinicians.