Safer Surgery part 29. There have been few research investigations into how highly trained doctors and nurses work together to achieve safe and efficient anaesthesia and surgery. While there have been major advances in surgical and anaesthetic procedures, there are still significant risks for patients during operations and adverse events are not unknown. Due to rising concern about patient safety, surgeons and anaesthetists have looked for ways of minimising adverse events. | 254 Safer Surgery knowledge of anaesthetic practice. Expertise in anaesthesia as in other fields of practice rests on the successful relationship between these different forms of knowledge. There is explicit knowledge which is capable of being written down codified and communicated in textbooks and journals and set out in examination syllabuses. There is also tacit knowledge defined as knowledge that has not been and perhaps cannot be formulated explicitly and therefore cannot be stored or transferred entirely by impersonal means MacKenzie and Spinardi 1995 p. 45 . It is typically acquired via demonstration followed by practice. Our work has begun to unravel the relationship between formal knowledge and the knowledge born of experience in expert anaesthetic practice. Formal training in communication skills is to be welcomed but we would suggest that a substantial amount of teaching and learning of these skills goes on almost unrecognized during the kinds of interactions we have documented. The danger of course is that if safe effective care depends on the understanding of informal idiosyncratic procedures and communicative devices then staff who are not familiar with them pose a threat. These may include locum and agency staff and those from overseas or otherwise different working cultures. There does not seem to be a great deal in the research literature on how relationships between members of the interprofessional team are negotiated. In the context of handovers there is a substantial body of research on nurse-to-nurse handovers Kerr 2002 Manias and Street 2000 Sherlock 1995 and some recent interest in handovers between doctors Horn et al. 2004 Solet et al. 2005 but little work exploring interprofessional handover. Our data suggest that nurses may sometimes be manoeuvred into taking the responsibility for setting the boundaries of doctors safe practice - for instance in saying when they consider the anaesthetist can safely leave the patient and return to the .
