Circulation 80,350 • Volume 21, No. 4 • Winter 2006   Issue PDF

All Agree – Alarms Must Be Audible

Iris Horton, CRNA; Thomas R. Russell, MD, FACS

Letter to the Editor

I wanted to share an experience with you that may cause you to question the status of patient safety. For nearly 24 years I worked with a large physician/CRNA group. The bulk of my practice was at an outpatient surgery center. It was at that site that I challenged a surgeon about his loud music interfering with patient care; specifically, the music prevented me from hearing my monitors and alarms. He was offended. My attending anesthesiologist, when called to the operating room, agreed with my concern regarding the loud music and explained to the surgeon that it is a requirement to hear the monitors.

Shortly after this occurrence, the medical director of surgery center advised me that I was being moved to another work site due to surgeons being unable to work with me. In fact, it is my belief that the “offended” surgeon used his ability to bring cases to the surgery center to exert pressure to have me no longer assigned to the surgery center. I no longer work for the group. I have no regrets for standing up for “what is right.”

I hope this letter influences at least one person, in the future, to stand up for patient safety when challenged by unreasonable demands of a surgeon. The safety of the patient comes first; it is mandated that the monitors and alarms must be audible. Providing a surgeon an environment in which to work is second. This includes background music.

Iris Horton, CRNA
London, KY

In Response:

In her letter to the editor regarding audible alarms and background noise, Iris Horton, CRNA, offers a striking example of how unprofessional conduct can put a patient’s safety at risk. This nurse anesthetist should be commended for taking a strong stance that the surgeon’s background music be kept to a volume that would allow other health care professionals in the operating room to clearly hear the monitors and alarms. Indeed, all potential distractions and disruptive behaviors pose a threat to patient care.

As a professional organization dedicated to safeguarding the surgical patient and ensuring that operative care is provided in an optimal environment, the American College of Surgeons expects its members to put the interests of patients ahead of their own. As a result, we are strongly encouraging surgeons to disabuse themselves of outmoded conceptions about their role in the operating room. We realize that given the complexity of surgical care today, surgeons can no longer view themselves as “the captains of their ships,” with the rest of the crew on hand simply to carry out their demands—no questions asked. Instead, we are fostering a team approach to patient care, with surgeons listening to and weighing input from all of the team members, including technicians, nurses, anesthesia professionals, and residents. Clearly, any recommendations concerning conditions that affect a team member’s ability to hear monitors or audible alarms would be taken seriously under this approach. We believe that this system will help to improve morale, reduce errors, and increase safety—all of which will provide our patients with better outcomes and healthier lives.

Again, we applaud Ms. Horton’s efforts to advocate for her patient’s safety and anticipate that stories like hers will soon become a throwback to the past.

Thomas R. Russell, MD, FACS
Executive Director, American College of Surgeons


The Council on Surgical and Perioperative Safety

Endorses the importance of the anesthesia professional being able to hear audible physiologic alarms unobstructed by extraneous operating room noise.


American Association of Nurse Anesthetists

American Association of Surgical Physician Assistants

American College of Surgeons

American Society of Anesthesiologists

American Society of PeriAnesthesia Nurses

Association of periOperative Registered Nurses

Association of Surgical Technologists