Marlot Kuiper

175 Checklist as ‘hub’: On routine interactions thus already has been waiting (in anxiety) for multiple hours - they are the ones to tell the patient. This is where the ‘game’ of emergency construction comes in. The observation note shows how two scheduled trauma surgeries were put on hold because of two neurosurgery emergencies. In some cases there is no doubt about the level of emergency, but sometimes, the state of emergency is debated. ‘Emergency’ becomes something that is constructed by surgeons. They are inclined to present their patients as more urgent to make sure that there is an operating theatre for them available to operate, at the expense of other patients that were scheduled for surgery. In a conversation I had with the trauma surgeon during our waiting time, he expressed his dissatisfaction with the label ‘A emergency’ that one of the neuro patients got. “You can seriously doubt whether this indeed is an A emergency. It would have been possible to schedule this operation after ours was finished” he sighs. These squabbles over emergencies and rescheduling also directly affect the performance of the checklist routine. A first thing to mention is that the anaesthesiologist notices that information is missing. With a joke, he addresses the fact that both the information about the operator and the patient is missing. Next, because of a rescheduling of surgeries, the anaesthesiologist was busy elsewhere at the time the program could be resumed. The trauma surgeon therefore decided to continue the program. After a lot of waiting time, again waiting for the anaesthesiologist would have put pressure on the already tight schedule even more. Instead, tasks regarding anaesthesia were delegated to the nurse anaesthetist in the room (see paragraph 6.5.2 for a further consideration of the strategies that professionals develop). Because of their responsibility for two operating theatres, anaesthesiologist also constantly have to adapt. They have to flexibly move between operating theatres. The next subparagraph shows how the demand of being at two places at the same time is actually embedded in the surgical process from the start of the day onwards. 6.3.2 In two places at the same time? The surgery department schedules the various operations in which mostly one surgeon is responsible for the surgeries in the operating theatre planned that day, for example, a range of hip fractures or colon carcinomas. As programs are full and schedules tight, all operating theatres start at 8.00am. The anaesthesiologists 6