Time-Out Procedures In 2003, The Joint Commission mandated a universal proto- col requiring proper preoperative identification of the patient by the members of the catheterization laboratory team, marking of the operative site, and a final time-out just before the procedure.306 Although initially intended to prevent wrong-site surgery, this has been expanded to include all invasive procedures despite limited scientific evidence of its effectiveness.307 The intent of the time-out is for all members of the team to improve patient care by collectively discussing the case. The content of a time-out includes confirmation of the correct patient, correct side and site, agreement on the procedure to be performed, correct patient position, and availability of needed equipment, supplies, and implants. The timeout may be checklist driven or conversational, depending on laboratory preferences.308 The writing committee strongly endorses the practice of conducting a time-out before all PCI procedures. 4.2. Ethical Aspects The 3 principles of medical ethics are beneficence, autonomy, and justice. Beneficence involves the physician s duty to act in the best interests of the patient and avoid maleficence, or harm (primum non nocere). Autonomy describes the physi- cian s duty to help the patient maintain control over his or her medical treatments. Justice describes the physician s duty to treat the individual patient responsibly with due consideration of other patients and stakeholders in the healthcare system. Ethical considerations specific to PCI have been previously discussed309 and are highlighted below: Place the patient s best interest first and foremost when making clinical decisions (beneficence). Ensure that patients actively participate in decisions affecting their care (autonomy). Consider how decisions regarding one patient may also affect other patients and providers (justice). 