An Exploration of "Near-Miss" Events in Non-Operating Room Anesthesia Locations

Area of Science:

• Anesthesiology
• Patient Safety
• Healthcare Quality Improvement

Background:

• Non-Operating Room Anesthesia (NORA) settings present unique safety challenges due to variable resources and staffing.
• Near-miss events in NORA are often undocumented, hindering safety improvements.
• This study addresses the need for better understanding and reporting of NORA near misses.

Purpose of the Study:

• To determine the incidence and types of near-miss events in Non-Operating Room Anesthesia (NORA) settings.
• To identify key factors contributing to near-miss events in NORA.
• To provide data for improving safety culture and practices in NORA.

Main Methods:

• A prospective cohort study surveyed anesthesiology providers across various in-hospital NORA locations over 42 weeks.
• REDCap surveys were used to collect data on near-miss events, categorized by patient, provider, and environment.
• Data analysis included incidence rate calculation and logistic regression to identify significant contributing factors.

Main Results:

• A near-miss incidence rate of 3.22% was observed, with 90 events reported.
• Environmental concerns (83.3%) and poor group dynamics (34.4%) were the most frequent near-miss categories.
• Factors associated with near misses included older patient age, male sex, higher ASA status, longer/emergent procedures, and resident provider involvement (OR: 2.38, P = .02).

Conclusions:

• Systematic surveying effectively captured previously undocumented near-miss events in NORA.
• Environmental factors and team dynamics are critical areas for NORA safety improvement.
• A systems-wide approach fostering multidisciplinary collaboration and reporting is essential to enhance NORA safety.