Sir,

We read with interest the article and accompanying editorial on ‘The Patient Alert System’ (PAS).1, 2 The Edinburgh system was developed 3 years ago and incorporates tactile vibrating feedback through the hand piece once activated. The prototype lacked this feature and was similar to the Manchester device. Evaluation of the prototype showed patients were unsure if staff had noticed an audible alarm amidst the background theatre noises of the phacomachine, music, and conversation. Deaf patients found the tactile vibrating feedback device in the hand piece of particular benefit.

We agree that patient choice should determine if hand-holding or the patient alert system should be used. The latter was the preferred option in approximately 40% of patients in an evaluation of 50 consecutive patients undergoing cataract surgery in our unit. It is preferred by patients who may have poor hand-grip strength, arthritis, or who are unsure about the procedure of increasing grip as a means of attracting attention. This may in part reflect patient anxiety, cognitive dysfunction, and conflicting patient advice. For example, patients are instructed not to move under the drapes, yet when anxious, distressed, and sensorially deprived, moving a limb rather than increasing a squeeze on a hand is an instinctive method of requesting assistance.

The patient alert system is a tool for reducing patient anxiety by ensuring a clear method of communicating distress from patient to surgeon. In order to pre-empt the possibility of patient movement in a population who are likely to have communication difficulties and poor appreciation or ability of increasing hand grip as a method of signifying distress, we suggest the Edinburgh patient alert system as a simple cost-effective strategy.