Marlot Kuiper

224 Connective Routines The checklist poster is put up at the wall, but because the operating theatre is quite spacious, the poster is positioned about three metres from the surgical table where the urologist is doing the time-out, and partly hidden behind the arm of the surgical lamp that is hanging across the surgical table, the urologist does not seem to notice the poster at all. After ensuring the patient that everything will be fine, he leaves to scrub. Although the posters are put up in the operating theatres of Plainsboro Teaching Hospital as a reminder so that doctors do not have to perform the checklist off the top of their heads, that is exactly what happens a lot. In this particular situation, the urologist does not pay attention to the poster, but performs some of the checks out of memory. The poster is out of reach – literally. The urologist is not able to sufficiently incorporate the poster in the procedure, let alone hold the checklist in his hands. Consequently, he addresses safety items that are in his memory. Besides, the surgeon mentions some of the items, rather than asking questions to the patient and the team. The artefact’s affordances make that professionals are inclined to routinize ‘checking safety items’ rather than routinizing the artefact. In this situation, there is attention for safety items, but not in systematic way incorporating the checklist - let alone with a shared focus of the surgical team. The checklist routine turns out a solo performance by the surgeon, who covers some items out of memory. In St. Sebastian’s, the checklist has to physically enter the operating theatre together with the patient, indicated individuals have to tick off the checks after confirmation, and, as the introductory note of this chapter illustrates, the checklist has to be handed over when taking the patient to recovery. The registration of the checks thus comes directly with the performance of the checks. The following observation note illustrates how the paper checklist was used during one of the time outs. When I’m at St. Sebastian’s, I shadow anaesthesiologist dr. Kronbach. We are at OR8 for the time-out. When everyone is in the theatre, the surgeon instigates the time-out by asking everyone to gather around the surgical table. First, the surgeon himself asks for the patient’s identity and the surgical side. Then he asks the patient: “Can you tell us in your own words what we are going to do today?” After confirming the intervention, he directly speaks to the scrub nurse to check if all equipment is available. Lastly, he asks dr. Kronbach: “Any allergies known?” To which dr. Kronbach replies that the patient is allergic to iodine, he confirms antibiotic