LETTERS TO THE EDITOR

In Response

We thank Dr Keane and Manikappa¹ for taking the time to offer their insightful commentary on our recent article discussing the quality of the implementation of the perioperative time-out in routine clinical practice.² While we agree that adherence to the time-out should not be to the exclusion of safe patient care, the fact remains that adherence to the World Health Organization safe surgery checklist, and variants thereof, is beneficial in avoiding complications and death.³ Of course, with that being said, we completely agree that malicious obedience to the checklist process is clearly not beneficial to the patient. One should never let a time-out be the death of common sense. In instances in which a patient is unstable or deteriorating, the time-out should be delayed as long as necessary. As we have demonstrated, many interruptions to the perioperative time-out are actually beneficial to the patient, highlighting or identifying issues that may lead to serious patient harm. While postinduction and preincision are high-risk periods, the ability to simultaneously monitor and take care of our patients and participate in the perioperative time-out may simply be a core competency to function as an anesthesiologist.