SOS: Seeking outcome success in vascular surgery

The Morse code letters SOS do not stand for “save our ship,” but were chosen by the International Radio Telegraph Convention of July 1908 because this combination of . . .—. . . was easy to send and recognize. When the ship Titanic was sinking on April 15, 1912, the new signal SOS was sent for the first time from a sinking ship. The Californian was nearby, but as no one was manning the radio room, no one heard the Morse code distress signals. The Carpathia steamed from 58 miles away to rescue 711 survivors. After this disaster, ships were required to monitor their radios 24 hours a day. Technology has changed, and now distress signals from ships at sea are sent from emergency locators that pinpoint their location with signals bounced off satellites. In 1995, the United States Coast Guard ended the use of Morse code transmissions in its maritime communications service. But if a ship were to send a Morse code SOS signal, rescue efforts would likely be initiated. . . if anyone were listening. Surgeons, perhaps uniquely in the practice of medicine, are rewarded by outcome success in their endeavors but are also burdened by their failures. If a patient exsanguinates while you attempt operative control of arterial injury or suffers a stroke during carotid endarterectomy, it is hard to say the blame does not weigh on your conscience. If we, as surgeons, listen to our conscience in future endeavors, we may be able to decrease our mistakes. An objective assessment of complications on our own vascular service judged 68% to 79% of “avoidable complications” to be technical errors such as early graft failure. The focus of such monitoring now is on attempting to identify opportunities for improvement.