Marlot Kuiper

225 prophylaxis given, and indicates no further patient specific concerns. After the surgeon ticked-off each of these boxes, he confirms that they’re ready to get started, so we can move on to the other theatre. When we get back at OR8 after a while, the operation is finished and the sing-out has already been done – as the nurse anaesthetist tells us, and the next patient is already on the table. Again, the time-out is been done extensively, led by the surgeon who reads out the items from the checklist he is holding in his hands. The scrub nurse confirms the equipment, and dr. Kronbach confirms no allergies, and that two packages of blood have been ordered, “just in case.” Meanwhile, the nurse anaesthetist is preparing the patient for surgery. He is attaching her to the monitors while they are having some chitchat about the weather and holidays. The paper checklist clearly indicates roles and responsibilities, and that does seem to provide routine participants with some guidance. The observation note illustrates how the surgeon directly speaks to his colleagues as indicated in the form. Items are systematically being checked. During the first time-out as described in the first part of the observation note, there indeed seems to be focused attention of the team; the whole team gathers around the surgical table and focuses on the time-out, items are confirmed and ticked-off on the piece of paper. It must be noted still, that active involvement of all actants, and thus focused team attention, is not guaranteed. In the second time-out as described in the second part of the observation note, the anaesthesiologist confirms the items, so these checks have been taken care off. However, in a short while the anaesthesiologist will leave the theatre, and the nurse anaesthetist who was chitchatting during the time-out, will monitor the patient. In other words, as specific actants are spoken to, others might very well keep on continuing their tasks, as they precisely know when their active involvement is required, and when not. As the anaesthesiologist was taking care of the anaesthesia items in the time-out, the nurse anaesthetist knew that he would not be spoken to. The following short note is taken about 30 minutes later, during the operation itself: When the operation is halfway, the surgeon mumbles “we have quite some blood loss here.” Although he seems to mostly speak to himself, the nurse anaesthetist replies: “We did order blood, did we?!” 7