Marlot Kuiper

188 Connective Routines the surgeon anywhere – without success. “Okay then, I am going to do something else as well” he says, apparently mostly to himself. To the scrub nurse he says: “Please call me when he returns.” We head back to the staff room. About ten minutes later the scrub nurse calls to inform us that the surgeon has returned and we can come for the time-out. At that time, however, we are already busy signing out in the other operating theatre. The anaesthesiologist asks the nurse anaesthetist to take over his tasks and says, “You know the patient better than I do.” In this situation, again an anaesthesiologist faced different care demands at the same time: a time-out in one theatre and a sign-out in the other. In order to not further delay the process, the anaesthesiologist decided to complete the task he was working on, and asked the nurse anaesthetist in the other theatre to take over his tasks there. During a coffee break later on, I asked the anaesthesiologist about this ‘outsourcing’. He acknowledged that formally he was responsible and not allowed to delegate this work to someone lower in the hierarchy. However, trying to unite incompatible demands seemed unrealistic and thus unsafe, while this delegation seemed a reasonable option. The nurse anaesthetists are skilled, and they monitor the patient in the operating theatre the whole time, and therefore they do sometimes know the patient’s situation better than the anaesthesiologists. Moreover, they can always call for assistance. When I asked the anaesthesiologist if he felt uncomfortable with this situation he replied, “That’s why I made the call afterwards, just to be sure.” In the introductory note of this chapter, the anaesthesiologist was confronted with the same kind of incompatible demands, he simply couldn’t attend the briefing in two theatres at the same time. He therefore prioritized the briefing and time-out of the more complex surgery, at the expense of procedures in the other theatre. The orthopaedic surgeon was already busy placing a knee prosthetic. Later on, it showed that in this OR, there was a final-year anaesthesiologist in training attending. The anaesthesiologist was supervising the anaesthesiologist in training. He explained that they could get along very well and that he had a good impression of the competencies of the anaesthesiologist in training. Besides, she could always make a call in case she needed help.