Marlot Kuiper

174 Connective Routines with the program. However, there a two patients on the neurosurgery A-emergency list 17 , which means that our program is ‘on hold’, since the neurosurgeon has to operate these patients in the theatre where our operations were scheduled. In these two hours of ‘waiting time’ we attend two meetings, attend a master thesis defence, and visit colleagues at the emergency department who are treating a 92-year-old patient who fell out of her stair lift. At 2.00pm the program can be resumed. The morning briefing is exactly six hours ago when dr. Doornwaard performs the time-out. He is holding the memory board 18 in his hands while listing the items. As the anaesthesiologist is not present, the nurse anaesthetist confirms the items. When the anaesthesiologist enters the operating theatre about twenty minutes later, he jokes: “Who are you people?! I don’t see any names on the board! And who are you operating?!” At the start of the day, with the two scheduled operations, the names and phone numbers of dr. Doornwaard and the anaesthesiologist were on the white board, as was the patient information. When the program was put ‘on hold’ because of A-emergencies that were operated by the neurosurgeon, the information was correctly erased from the board. However, when the program was resumed two hours later, the correct information was never put back on. A day at the trauma surgery requires multiple acts of rescheduling. Some situations demand immediate action and involve high time pressures, while at the same time, trauma surgery can involve a lot of waiting time. Despite emergency is expected, it requires high levels of flexibility and decisions on the spot. Especially waiting time is considered as tremendously annoying. Because of a chronical lack of time, operation schedules are tight, and to surgeons it is of great importance that ‘their’ patients get operated. If surgeons run out of time and the operation of the last patient of the day has to be postponed – who then 17 There a three types of emergency; A, B and C. The surgeon who is responsible for the patient, determines the level of emergency for the sake of triage. 18 Chapter 7 is about the role of artefacts. In this chapter I show how different representations of the checklist influence performances.