Influence of online commentaries (ONC), metacommentaries (MC) and offline commentaries (OFC) in team decision-making processes, abbreviated summary of findings
| Discourse types | Findings | Examples |
| ONC | Created attention and indicated critical situations. Triggered action. (Re)distributed tasks and responsibility. Created progression in team decision processes. | Nurse anaesthetist: ‘It is bleeding in the mouth here.’ Leading to: The anaesthetist leaves the CT-discussion and walks up to the nurse anaesthetist to manage the bleeding problem (excerpt A, online supplementary appendix 1, utterance 304 and following). |
| MC | Triggered action. (Re)distributed tasks and responsibility. Oriented both towards acknowledgements and doubts of expertise. Created progression in team decision processes. Consecutive MC signalled urgency. | Anaesthetist: ‘I haven’t fetched the defibrillator.’ Leading to: emergency department (ED) nurse 1 announces that she will fetch the defibrillator and the automatic chest compression machine, and the nurse anaesthetist asks for a bag-valve-mask. (Excerpt B, online supplementary appendix 2, utterance 293 and following). Anaesthetist: ‘But is it-. Should a pericardiocentesis be done, or is it-?” acknowledging the present team’s expertise in decision-making. The lack of response results in her rephrasing the question: ‘Has a thoracic surgeon been called? Or a thoracic anaesthetist- to come and assess- (3 s pause) In terms of status.’, challenging the present expertise including her own, and distributing the responsibility of seeking necessary expertise to the others. (Excerpt C, online supplementary appendix 3, utterance 395 and following). Anaesthetist: ‘Must have suction now!’, ‘I need it now! (8) Can you watch out for his arm.’, ‘Suction in the mouth.’, ‘Suxamethonium and fentanyl’ Leading to: ED nurse 1 sets up the suction device and starts suctioning secretions from the patient’s mouth, the nurse anaesthetist delegate inserting a stylet in the tube to the nurse anaesthetist student while managing the medication herself. (Excerpt D, online supplementary appendix 4, utterance 228 and following). |
| OFC | Expressed the speaker’s expertise. Sought mutual understanding. Created a broader base for decisions. Put the team decision processes temporarily on hold. | ED physician 1 question: ‘Are we 100% sure that it is the heart?’ seeking more evidence. And in his next utterance, ‘It isn’t hypoxia’ he provides an explanation framing his expertise putting the decision temporarily on hold. (Excerpt A, online supplementary appendix 1, utterance 284 and following). |
| ONC conflating into MC | Seemed to ‘speed up’ team decision processes. | Anaesthetist: ‘No contact. I think we’ll intubate.’ Leading to: Physician one turns towards the anaesthetist nodding, the nurse anaesthetist asks for confirmation and starts preparing for the intubation, and ED nurse one reports the patient’s oxygen saturation. (Excerpt D, online supplementary appendix 1 , utterance 223 and following). |