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

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.