Three perspectives of rounds: Choreographing information flow in an intensive care unit

Communication in acute hospital care occurs frequently in group settings, with "rounds" as the prototypical forum for care providers to review and plan for patient care. Many care providers spend hours each day in rounds. While studies have demonstrated the importance of rounds as a mechanism to improve care coordination, care providers frequently express frustration about rounds. Previous observational studies of rounds have identified factors influencing information transfer: physical, social, cognitive, and supporting artifacts. In this paper, we adopt three perspectives in advancing our understanding of communication during rounds and in devising interventions: distributed cognition, computer-supported cooperative work, and common ground. We use video recordings of rounds discussion of one patient in a pediatric intensive care unit to illustrate the choreography of information flow aided by artifacts, the use of visual "text" in discourse, and the scaffolding process of incrementally building a shared understanding about the care and the status of the patient. We highlight the importance of detailed studies of communication in embedded work practices and the need for a multi-theoretical approach for future studies of communication.