This prospective, case-controlled observational study assessed whether an evidence-based extubation checklist would increase anesthesia providers' documentation of standardized extubation criteria and reduce the occurrence of preventable extubation failures in the early postoperative period. The sample consisted of 622 ASA Physical Status I to IV patients, aged 10 to 100 years but primarily adults, who underwent elective and emergency surgeries at a university-based adult trauma teaching hospital. Before the study, all anesthesia and postanesthesia care unit staff received an in-service on adherence to an evidence-based extubation checklist, followed by implementation of the checklist for 12 weeks. Demographic data, anesthesia flow sheets, provider notes, and quality assurance records were reviewed to determine utilization of the checklist before extubation and to ascertain those patients who required reintubation. Following use of the extubation checklist, documentation of patient readiness for extubation increased from 54% to 92.5%, and extubation failures decreased from 2.5 per month to 7.2 per month. This study confirmed that extubation failure occurred less frequently when the extubation checklist was used (P = .001, Fisher exact test). Study results indicate that an extubation checklist may positively influence provider documentation of evidence-based criteria for extubation and can reduce the occurrence of preventable extubation failures.