The time-outs were based on pre-flight checklists adopted by airline pilots and were instituted in all accredited hospitals and ambulatory care centres in the United States in 2003. The guidelines originate from general surgery and are not specific for the various surgical specialties. This study describes the results of a survey on the neurosurgical ‘time-out’ procedure at five hospitals in the United States. The surveys were sent to 51 neurosurgical faculty fellows and had a 72.5% response rate. The authors observed that although time-outs are a standard of care, there is considerable variability between hospitals in the actual practice of the time-out. In some hospitals, the time-out was led by the attending consultant while, at others, the fellows or residents. The time-out was performed either before or after anaesthesia and there was no standardisation. The authors conclude that time-outs have altered the practice of surgery, and specialty specific time-out enhancements would further improve the process. We may want to tailor time-outs for otolaryngology and head neck surgery too.