Defining near misses: towards a sharpened definition based on empirical data about error handling processes

Area of Science:

• Healthcare Quality and Safety
• Medical Error Analysis
• Patient Safety Research

Background:

• Medical errors are frequent, and complete prevention is impossible.
• Strategies for timely error detection and correction are essential alongside error reduction.
• Near misses (incidents without patient harm) offer valuable insights into error recovery.

Purpose of the Study:

• To establish the need for a clearer, consistent definition of near misses.
• To enable large-scale reporting and analysis of near misses for improved healthcare safety.
• To gather information on successful error recovery mechanisms.

Main Methods:

• Qualitative incident reports and interviews were collected from two Dutch general hospitals.
• Analysis of 143 error handling processes associated with incidents.
• Comparison of error handling for incidents that reached the patient versus those that did not.

Main Results:

• Different incident types provide unique information about error handling.
• Error handling processes differed significantly between incidents that reached patients and those that did not, due to successful countermeasures.
• Proposed definitions for near misses could facilitate large-scale reporting.

Conclusions:

• A clearer definition of near misses is needed for effective analysis and reporting.
• The optimal definition of near misses may depend on the organizational context.
• Analyzing near misses can proactively improve care quality by identifying failure factors, enhancing error interception, and strengthening safety culture.