Marlot Kuiper

179 Checklist as ‘hub’: On routine interactions 6.3.3 Sign-out for now, arrangements for later The sign-out is the third and final part of the checklist that has to be performed just before the patient leaves the operating theatre. During the sign-out, the scrub nurse has to confirm to the team that all gazes, sponges and needles used during the operation are complete. The final item of the sign-out part of the checklist is the confirmation that the team has reached definite agreement upon follow-up treatment. Strikingly, in nearly all the performances of the sign-out observed, the surgeon replied something like: “Will do!” This item of the checklist is situated in the process where the team is focusing on rounding off of the intervention, cleaning up materials, putting information in the system, and ticking off the boxes. Thus, at the time the item has to be confirmed, they literally didn’t have any time yet to actually make arrangements for follow-up. By confirming “Will do” however, nothing more than the intention to make arrangements for later has been confirmed. 6.4 Unexpected events A second category of disturbances, is caused by unexpected events. It is important to note that ‘unexpected’ does not mean that such events are rare. Rather, unexpected events happen on a regular basis, but I use the framing ‘unexpected’ because their occurrence in the surgical process is unexpected. As in trauma surgery we can expect emergency, and emergency is even ‘scheduled’, in other domains emergency can arise more unexpectedly. As from the organisation of the process we can expect a standard problem of not being able to be present at two places at the same time, sick colleagues and scared patients present on a regular basis, but at unexpected moments. In this paragraph, I will explain how emergencies, delays and changing team compositions lead to incompatible demands for checklist performances. 6.4.1 Emergencies While emergencies are the defining principle of trauma surgery, emergencies may also occur in other subdomains of surgery. Emergency then, is not only limited to the condition of the patient, but can also relate to other tasks and their unpredictability that have to be taken care of for a smooth flow of the process. 6