Table 2. Supporting factors and barriers to effective documentation of structured team-based discussions, with illustrative quotes.

Type of structured discussion	Supporting factors	Barriers
Multidisciplinary ICUa rounds	Structured rounding frameworks promote organized, systems-based documentation “Our rounding discussion is very structured and systems-based; an [ambient AIb scribe] could capture that and turn it into a clear assessment and plan.” (ICU attending 7) EHRc smartphrases and templates “The auto-populate stuff is somewhat helpful, but it mainly pulls in objective data. Still, smartphrases and templates let us finish some notes in minutes.” (ICU attending 3) “You have to like good smartphrases if you want to document well.” (ICU trainee 1) Professional expectation for daily documentation “It’s kind of a painful process for me, but it also helps me to crystallize my thinking and be able to articulate my thoughts. The attending addendum helps me to synthesize in a very clear manner my assessment of the patient overall and the plan going forward.” (ICU attending 4)	Time pressure “The biggest one is time constraints … you try to do the bare minimum and leave, which then leaves gaps in documentation.” (ICU attending 8) “Most of the time I go home and I have not been able to complete my ICU notes for the day.” (ICU attending 9) Note-writing interruptions disrupt cognitive flow during writing “If a patient is crashing, there’s no way to get to documentation; most days I’m finishing at home, off the clock.” (ICU attending 10) Competing clinical demands “You either need to make a decision on whether you’re going to be taking care of a patient or focusing on your documentation.” (ICU attending 9) “I do need to carve out at least an hour, and that means that’s just less time to actually do bedside teaching. and patient updates with family members.” (ICU attending 11) Information loss from the discussion “But even as I’m writing the note and reading through it again, and trying to think- even after I’ve signed notes sometimes- I’ll remember something that I meant to write down or that we talked about and didn’t put in the note, and have to go back and change it again.” (ICU attending 5)
Handoffs and transitions of care	ORd-to-ICU handoff checklist serves as a strong scaffold for documentation “The CTe and SICUf OR-to-ICU handoff is highly structured; with a little training the scribe could create a note for it.” (ICU attending 2)	Handoff documentation is not routinely practiced and may encounter resistance if perceived as adding to clinicians’ workload “We don’t currently put handoffs in a note- is the handoff going to take more time if we have to verify a note?” (ICU attending 4)
Goals-of-care discussions	Documenting changes in a patient’s code status is an expected standard of care “The goals-of-care conversation would be a prime target for the [ambient AI scribe].” (ICU trainee 2)	Nuanced clinical conversations are often difficult to fully capture in written documentation “These conversations are really complex. Our ability to write out the nuances of these conversations efficiently and effectively isn’t always possible.” (ICU attending 13)

^aICU: intensive care unit.

^bAI: artificial intelligence.

^cEHR: electronic health record.

^dOR: operating room.

^eCT: computed tomography.

^fSICU: surgical ICU.