We thank O'Sullivan et al. for their comments [1] on our article [2], continuing an essential discussion on the use of checklists in anaesthesia, and especially in airway management. Evidence regarding the use of checklists for tracheal intubation is indeed limited. However, a few studies hint at the indirect benefits of its use. The NAP4 report [3] states that airway-related complications are rare but occur in around 1:10,000 procedures and can be potentially catastrophic for the patient and the healthcare team. Therefore, the interpretation of the systematic review by Turner et al. needs caution. This review, with less than 3500 patients, was probably underpowered for death as the primary outcome [4].

The checklist we used for our research project was created based on previous evidence. This locally developed pre-induction checklist emerged from a 1-y ‘before and after’ study in one large anaesthesia department, pinpointing all airway-related events over 18 weeks [5]. It demonstrated that changes in the behaviour of anaesthetists led to a reduced incidence of adverse airway events. As the checklist was used for more than a year during the study, the anaesthesia personnel became used to it and decided to keep it as a safety standard. Of relevance is that healthcare safety is traditionally seen as the absence of adverse events [6], or “Safety-I.” However, in recent years, the safety research community has switched to a greater focus on complex systems and the consequences of collective efforts to adapt to dynamic conditions and uncertainty. This approach, “Safety-II”, is more aligned with the apparent ‘non-evidence-based’ use of checklists [6].

We read with interest the checklist fatigue issue, a phenomenon we did not observe. In our setting, where we train in team simulation, the pre-induction checklist aims to stimulate a briefing before the induction of anaesthesia, especially regarding discussions of plans A, B and C. Such interventions have been shown to improve team effectiveness [7]. O'Sullivan et al. correctly reference Grigg's article regarding the importance of minimising such checklist fatigue and the cultural component of checklist buy-in. In my anaesthesia department, the checklist was implemented as a top-down decision by the most senior staff, as a safety step. It was broadly accepted, but not in all situations [2]. We also hypothesise that the widespread adoption of literature, such as The Checklist Manifesto by Atul Gawande, may have further contributed to its acceptance. As he propagates, a checklist is a complex social intervention and “a tool that strengthens team performance.” As we have not observed checklist fatigue at a departmental level, we assume this checklist works; however, more effort in change management is required to achieve its use in all anaesthetic interventions.

我们感谢 O'Sullivan 等人。感谢他们对我们的文章 [ 2 ]的评论 [ 1 ] ，继续对检查表在麻醉中的使用进行重要讨论，尤其是在气道管理中。关于使用检查表进行气管插管的证据确实有限。然而，一些研究暗示了使用它的间接好处。NAP4 报告 [ 3 ] 指出，气道相关并发症很少见，但发生在大约 1:10,000 的程序中，并且可能对患者和医疗团队造成灾难性后果。因此，Turner 等人对系统评价的解释。需要谨慎。这篇综述纳入了不到 3500 名患者，可能不足以将死亡作为主要结局 [ 4 ]。

我们用于研究项目的清单是根据以前的证据创建的。这个本地开发的诱导前检查表来自一个大型麻醉科室的 1 年“之前和之后”研究，在 18 周内查明所有与气道相关的事件 [ 5 ]。它表明，麻醉师行为的变化导致不良气道事件的发生率降低。由于检查表在研究期间使用了一年多，麻醉人员习惯了它，并决定将其作为安全标准。相关的是，医疗保健安全传统上被视为没有不良事件 [ 6 ]，或“安全 I”。然而，近年来，安全研究界已转向更加关注复杂系统以及为适应动态条件和不确定性而做出的集体努力的后果。这种方法，“安全-II”，更符合清单的明显“非基于证据”的使用[ 6 ]。

我们感兴趣地阅读了清单疲劳问题，这是我们没有观察到的现象。在我们进行团队模拟训练的环境中，诱导前检查表旨在促进麻醉诱导前的简报，特别是关于计划 A、B 和 C 的讨论。此类干预已被证明可以提高团队效率 [ 7 ] . 奥沙利文等人。正确地参考了 Grigg 的文章，该文章关于最大限度地减少此类清单疲劳的重要性以及清单购买的文化成分。在我的麻醉科，检查表是由最资深的工作人员自上而下地实施的，作为安全步骤。它被广泛接受，但并非在所有情况下 [ 2 ]。我们还假设文学的广泛采用，例如Atul Gawande的清单宣言可能进一步促成了它的接受。正如他所宣传的那样，清单是一种复杂的社会干预措施，也是“一种增强团队绩效的工具”。由于我们没有在部门层面观察到清单疲劳，我们假设该清单有效；然而，需要在变革管理方面付出更多努力才能在所有麻醉干预中使用它。