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doctors may not do so either [14]. Attempts have been made to standardize and improve a specific communication genre that is likely to occur during a deteriorating patient’s course, i.e. handover [15]. Handover (also called handoff) is defined as the process of information, authority and responsibility transfer for a patient from one clinician to another [16]. It is difficult to know the effects of handover interventions on patient outcome [17]. More research is required about why junior doctors communicate as they do. How and when junior doctors receive and send communication about the deteriorating patient is influenced by both their clinical roles and their information and communication technology (ICT) [18]. For instance, deteriorating patient communications are a relatively small part of a junior ward doctor’s large total communication load and need to be differentiated from routine messages [19]. Junior doctor specialty will also affect communication load [20]. Message prioritisation and allocation can be achieved technologically, although clinicians can and will circumvent this if it does not suit their personal purposes [19]. Individuals may also configure communication technologies to suit them e.g. their mobile phones. Where communication technology problems exceed the individual and span an organisation, this may be addressed by changing how the technology is used rather than by changing the technology in itself [21]. Although junior doctors prefer communication technology which is easy to use and increases their personal efficiency, it is unclear which physical device and software combination will achieve this [22,23]. Junior doctors do not have a consistent preference for any one hospital communication system, although generally they are dissatisfied with locators and prefer mobile phones [23]. Closer examination of junior doctor mobile phone usage reveals more complex preferences. Examples include preferences for different communication software in different contexts, and different preferences for communication devices between message senders and receivers [23]. A single device and software combination that addresses all requirements may be impossible, and if technological combinations are used this will likely evolve with time and context [24]. The usage of ICT is thus nested within hospital systems [25]. Consequently, the term information and communication technology (ICT) system is used here to reflect a broad sociotechnical interpretation of technology and context. Software mode is used to refer to a group of software programs sharing similar communicative properties separate to the physical devices hosting them, e.g. task management systems [22]. Whilst physical device types may also share properties e.g. landline and mobile phones, they often have more dissimilarities in other features like mobility and configurability. Either way, both the physical device [26] or the software sending mode [23] can affect how clinicians interpret messages. Pre-existing communication and communication technology theories do not wholly address the above issues. Communication challenges do exist elsewhere (e.g. the airline industry) although healthcare has specific communication characteristics and needs [27]. The healthcare domain has high cognitive demands from information complexity, unpredictable interaction within different specialties and frequent transfer of responsibility [28]. Morrow and Lopez [28] highlighted information processing, persuasion and risk communication, communication as interaction and common ground theories as being relevant to healthcare communication. These theories have not been used in the specific context of junior doctor communication about deteriorating ward patients. Theories concerning junior doctor usage of ICT systems are also limited in that they may only consider a single device or mode, rather than the multiple choices available at one time. Present ICT adoption theories also may not consider contextual J.Liangetal. / JuniorDoctorCommunicationSystemsand theDCMT124